COVID-19 Vaccine Clinical Guidance Summary for Patients with Rheumatic and Musculoskeletal Diseases (Part 7)
Let me refresh your memory on certain terms used in this column.
RMD means rheumatic and musculoskeletal disease and AIIRD. This refers to autoimmune and inflammatory rheumatic disease.
The timing consideration for people with RMD and AIIRD is important.
Indeed, it is important to time the vaccinations so they would happen one week prior to the next dose of intravenous abatacept.
It is best to hold for one to two weeks (as disease activity allows) after each COVID vaccine dose when using abatacept SQ.
When using acetaminophen and non-steroidal anti-inflammatory drugs, assuming that the disease is stable, hold for 24 hours prior to vaccination. No restrictions on use post vaccination once symptoms develop.
When using Belimumab SQ, it is best to hold for one to two weeks (as disease activity allows) after each COVID vaccine dose.
As far as drugs such as TNFi, IL-6R, IL-1R, IL-17, IL12/23, IL-23, and other cytokine inhibitors are concerned, the experts failed to reach consensus on whether or not to temporarily interrupt these following each COVID vaccine dose, including both primary vaccination and supplemental (booster) dosing.
When using Cyclophosphamide IV, it is best to time administration of the drug so that it will occur approximately 1 week after each vaccine dose, when feasible.
When using Hydroxychloroquine, there are no modifications to either immunomodulatory therapy or vaccination timing.
Talking about Rituximab or other anti-CD20 B-cell depleting agents, it is best to discuss the optimal timing of dosing and vaccination with the rheumatology provider before proceeding.
For all other conventional and targeted immunomodulatory or immunosuppressive medications (e.g., JAKi, MMF) except those listed above, it is best to hold for one to two weeks (as disease activity allows) after each COVID vaccine dose.
The idea is to closely work with your rheumatologist when it comes to dosing strategies for Covid vaccine.