Atlanta, February 11, 2021 (GLOBE NEWSWIRE) – American College of Rheumatology (ACR) has released its Summary of COVID-19 vaccine Clinical Guidelines that provides an official recommendation to vaccinate rheumatology patients with muscular, inflammatory and autoimmune diseases.
“Although there is little data from large population-based studies, patients with autoimmune diseases and inflammation appear to be at higher risk for developing COVID-19 in hospital compared to the general population. population in general and that they have worse outcomes associated with infection, ”said Dr. Jeffrey Curtis, chair of the ACR COVID-19 Vaccine Clinical Leadership Action Group. “Based on this concern, the benefit of the COVID-19 vaccine outweighs the small potential risks of new or post-vaccination autoimmune reactions.”
The guide was developed by a multidisciplinary panel of nine rheumatologists, two infectious disease specialists, and two public health specialists and is intended to provide guidance to providers treating rheumatology patients on how best to use COVID-19 vaccines. use, as well as the implementation of immunization strategies for rheumatology patients.
“Our members are plagued by questions and concerns from their patients about whether they should receive the vaccine,” said Dr. David Karp, President of the ACR. “We hope the guidance will provide them with evidence-based assurance that their patients will benefit from vaccination and guidance on how best to incorporate them into their treatment plans to increase the effectiveness of vaccination. . ”
Important considerations and recordings on how to approach vaccination are included for patients with high disease activity and / or those taking immunosuppressive medications. These include recommendations to modify specific medications such as methotrexate, JAK inhibitors (e.g., baricitinib, tofacitinib, upadacitinib) and some biologists (e.g., abatacept and rituximab) that alter the response -protected system in ways that may affect vaccine response.
The panel based their recommendations on the use and timing of immunomodulatory drugs on evidence drawn from their immunologic effects as they relate to other vaccines and vaccine types. Therefore, these and other recommendations made by the task force should be considered as conditions.
There was strong debate on a number of issues such as the expected level of benefit from vaccination for patients receiving treatments that significantly alter or suppress the immune system (eg, high dose steroids), ”Said Curtis. “In the end, the task force agreed that in almost all cases, it would be appropriate to go ahead with vaccination and get at least part of the answer rather than cancel the vaccine, as delay does not provide any protection. As there was little direct evidence for these vaccines in rheumatology patients, the panel applied general immunologic principles to other vaccines to make recommendations on how they could better respond to vaccines. ”
“For example, a UK patient with a well-controlled disease may benefit from maintaining a dose of methotrexate immediately after vaccination,” Karp said. “For drugs with long dosing times such as rituximab, there are some situations where it may be beneficial to give the vaccine time when the last dose has been given to increase the effectiveness of the vaccine. We encourage clinicians to review the records we have provided in the summary for details on how they can prescribe a number of medications to ensure their success. ”
With the uncertainty as to when other types of vaccines will be available, the task force focused on the two COVID-19 mRNA vaccines available in the U.S. at the time of their consideration. No option for a single vaccine has been said to be superior, and it is recommended that patients receive whatever mRNA vaccines are available.
“With efficacy about the same for both vaccines, we felt it didn’t matter what brand patients received them. In reality, many people will have no choice, as access availability varies by location and area. Therefore, it was important to reassure providers and patients that this was not a reason to consider when discussing vaccinations. However, patients should adhere to the same vaccine brand for both injections, ”said Curtis.
The ACR has stated that recommendations in the guidelines should not replace clinical judgment, and decisions about individual patients should be made as part of shared decisions with patients considering the diagnosis. -their health status (s), level of disease activity, conventional therapies, risk of exposure to SARS-CoV-2 and geography. Patients are also encouraged to follow all public health guidelines regarding mask wear, body speed and other protective measures even after vaccination.
Future changes are expected with the guidance as there will be more safety and efficacy data about the two existing mRNA vaccines, other vaccine platforms, and a vaccine response specific to patients with rheumatic disease.
“This is very much a ‘living document’, and the task force already has plans to evaluate further data in the coming weeks,” Curtis said. “We desperately need direct evidence from high quality research. To further that goal, we would call on action for patients, providers and researchers to highlight the important ongoing research efforts to investigate the efficacy and safety of vaccines in rheumatology patients. ”
The ACR will hold a town hall with members of the executive group on Tuesday, Feb. 16, at 7:30 p.m. EST to discuss the guidelines and answer questions about the proposals. Members of the media are invited to attend and are encouraged to register online. Questions about the guidelines can be submitted when you register.
A peer-reviewed manuscript with additional details of the clinical studies, data, and points of discussion influenced the recommendations submitted for publication to Arthritis & Rheumatology. It will be available on the ACR website when published.
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About the American College of Rheumatology
The American College of Rheumatology (ACR) is an international medical association representing more than 7,700 rheumatologists and rheumatology health professionals with the mission to empower rheumatology professionals to excel in their specialty. In doing so, the ACR offers educational support, research, advocacy and practice guidance to help its members continue their innovative work and provide quality patient care. Rheumatologists are experts in detecting, managing and treating over 100 different types of arthritis and rheumatic diseases.
Jocelyn Givens American College of Rheumatology (404) 929-4810 [email protected]