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COVID-19 vaccination and antirheumatic therapy

Journal

RHEUMATOLOGY
Volume 60, Issue 8, Pages 3496-3502

Publisher

OXFORD UNIV PRESS
DOI: 10.1093/rheumatology/keab223

Keywords

COVID-19; vaccine; biologics; DMARDs; rituximab; methotrexate

Categories

Funding

  1. National Institute for Health Research (NIHR) Biomedical Research Centre (BRC)

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This article discusses the impact of immunosuppressive therapy on COVID-19 vaccination, proposing a suggestion to temporarily suspend treatment to improve vaccine effectiveness, and urging decisions on withholding immunosuppressive therapy to be made in advance without sufficient data support.
The coronavirus disease 2019 (COVID-19) vaccination will be the largest vaccination programme in the history of the NHS. Patients on immunosuppressive therapy will be among the earliest to be vaccinated. Some evidence indicates immunosuppressive therapy inhibits humoral response to the influenza, pneumococcal and hepatitis B vaccines. The degree to which this will translate to impaired COVID-19 vaccine responses is unclear. Other evidence suggests withholding MTX for 2 weeks post-vaccination may improve responses. Rituximab has been shown to impair humoral responses for 6 months or longer post-administration. Decisions on withholding or interrupting immunosuppressive therapy around COVID-19 vaccination will need to be made prior to the availability of data on specific COVID-19 vaccine response in these patients. With this in mind, this article outlines the existing data on the effect of antirheumatic therapy on vaccine responses in patients with inflammatory arthritis and formulates a possible pragmatic management strategy for COVID-19 vaccination.

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