COVID-19 Vaccine Clinical Guidance Summary for Patients with Rheumatic and Musculoskeletal Diseases (Part 4)
This week, our focus is on the use of certain therapies for patients with Rheumatic and Musculoskeletal Diseases in relation to Coronavirus disease (Covid) vaccine administration.
It is the consensus of the task force formed by the American College of Rheumatology (ACR) that the use of Hydroxychloroquine; intravenous immunoglobulintherapy (IVIg); apremilast; and glucocorticoids should be given to patients even if they are getting the vaccine or have gotten the vaccine.For the use of Sulfasalazine; Leflunomide; Azathioprine; Cyclophosphamide, Belimumab; oral calcineurin inhibitors; Prednisone, there is no need to modify the treatment schedule
even if the patient is vaccinated with the Covid vaccine.
The use of Mycophenolate, assuming that disease is stable, should be withheld for 7 days following the administration of the vaccine.
It is recommended to hold the use of methotrexate (MTX) for a week each time the patient receives a dose of an messenger ribonucleic acid (mRNA) vaccine dose, assuming the RMA disease is stable and controlled.
It is best to hold the use of MTX for 2 weeks after single-dose Covid vaccines as long as the disease is controlled.
The task force recommends that the use of Janus Kinase inhibitors should be suspended for a week following the administration of a dose of Covid vaccine.
It is wise to hold the use of abatacept SO a week before and a week after the administration of the first dose of Covid vaccine. There is no interruption in the treatment needed for the 2nd dose.
The use of abatacept via intravenous line or IV, it is best to give the vaccine four weeks before the drug use, and postpone the subsequent abatacept infusion by one week (i.e., a 5-week. There is no medication adjustment for the second vaccine dose needed.
The use of Cyclophosphamide IV should be given a week after the vaccine dose administration, it possible.The use Rituximab (RTX) assuming the disease risk is low, the inoculation series should be scheduled 4 weeks prior to next scheduled rituximab cycle; after vaccination, delay the use of RTX 2-4 weeks after final vaccine dose.
Assuming the disease is stable, the use of non-steroidal anti-inflammatory drugs (NSAID) is not recommended 24 hours prior to vaccination.
There are no restrictions on use of NSAID after vaccination to treat vaccine symptoms.