Q&A: COVID-19 Vaccination in Patients with Scleroderma, Vasculitis and Myositis - What We Know and What is Recommended
Summary by Sebastian Sattui, MD, MS
What type of vaccines are being used for COVID-19?
Currently two vaccines have been approved for use: the Pfizer and the Moderna vaccine. Both of these vaccines were produced using a novel vaccine technology called messenger RNA (mRNA) vaccines. Important points about mRNA vaccines:
- Although new, this technology has been studied for years, and studies for COVID-19 vaccines have completed all rigorous and proper phases prior to authorization.
- mRNA vaccines contain strands of genetic material for the virus. They don’t contain live virus and carry no risk for the development of the infection.
- mRNA from the vaccine does not interact with the person’s DNA.
- There is no preference over one vaccine over another.
Were patients with scleroderma, vasculitis or myositis, or patients taking immunosuppressive medications included in the vaccine studies?
No. Patients with rheumatic diseases such as scleroderma, vasculitis, and myositis were not included in the studies. However, there is no reason to expect that harms will exceed the benefits of vaccination in these patients. The effectiveness of vaccines, not only those for COVID-19, can be affected by the use of certain immunosuppressive medications. However, given the severity of the current pandemic, any level of protection is still important and it does still provide some benefit. As recommended by the American College of Rheumatology (ACR), the timing of vaccination with regards to some medications should be considered (see below).
Is there a risk of disease flare after the COVID-19 vaccination?
At the moment there is no information to confirm this. However, risks associated with COVID-19 infection are well-known including the risk of disease flare due to infection. The benefits of vaccination clearly surpass the risks at this moment.
Is there any official guidance regarding COVID-19 vaccination in patients with rheumatic diseases?
Yes. The ACR has released the "COVID-19 Vaccine Clinical Guidance Summary for Patients with Rheumatic and Musculoskeletal disease" (see below). As mentioned above, at the moment there is no direct evidence regarding COVID-19 vaccine safety and efficacy in patients with rheumatic diseases. However, the task force in charge of this guidance document has done an exhaustive review of the evidence including data regarding the use of other vaccines (for example, influenza) in patients with rheumatic disease. This guidance addresses specific points and concerns from patients and providers, but does not replace the need for a conversation with your rheumatologist.
Is COVID-19 vaccination recommended to patients with scleroderma, vasculitis, and myositis?
Yes. Patients with scleroderma, vasculitis, myositis and any other rheumatic should receive COVID-19 vaccines. The only contraindication to vaccination is allergy to vaccine components. Although vaccination should occur in the setting of well controlled disease, prompt vaccination should occur for those in whom vaccination is recommended irrespective of disease activity or severity.
When receiving the vaccine, should I consider any changes (stopping) to my medication?
The ACR has issued recommendations regarding timing or holding doses (skipping some doses) for some medications after receiving or prior to receiving the vaccine. This is done since some evidence suggests that by doing so it allows the body to increase its response to the vaccine, therefore being more effective.
Medications that might require modifcations, either skipping doses or timing vaccine with last dose include: methotrexate, JAK inhibitors (such as Xeljanz, Olumiant, Rinvoq), Abatacept (Orencia), Rituximab (Rituxan) and Cyclosphosphamide (infusion). Medications such as mycophenolate (Cellcept, Myfortic), azathioprine (Imuran) and prednisone (low or high doses) do not require any modifications. Any change to medications needs to be discussed with your rheumatologist.
After I receive my vaccine, should I do anything differently?
After vaccination, you should continue to follow the same public health rules and cautions as you have been doing so. Continue to wear a mask, social distance, wash your hands and avoid large gatherings or big crowds.
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