American College of Rheumatology Releases COVID-19 Vaccine Clinical Guidance

The American College of Rheumatology (ACR) has published guidance regarding coronavirus disease 2019 (COVID-19) vaccination for patients with rheumatic diseases, with emphasis placed on prioritizing immunocompromised patients to receive the vaccine. The new guidelines also list any modifications and timing considerations around immunomodulatory therapies and vaccine delay.

In order to ascertain reliable guidance, the ACR curated the North American Task Force panel, which consisted of 9 rheumatologists, 2 infectious disease specialists, and 2 public health experts. Over the course of several meetings held in December 2020 and January 2021, panelists created a list of clinical questions and that were then rated with a numerical score on level of agreement. Only questions with “moderate” (M) or “high” (H) agreement and importance were included in the draft.

Top Insights:

• Autoimmune and inflammatory rheumatic disease (AIIRD) patients should be prioritized for vaccination before the nonprioritized general population of similar age and sex
• As rheumatic and musculoskeletal disease (RMD) patients are immunocompromised, they should continue to practice social distancing even after receiving the COVID-19 vaccine
• Household members of patients with AIIRD should also be vaccinated to facilitate a “cocooning effect”
• Methotrexate and JAKi treatments should be held for 1 week after each vaccine dose, with no modification to vaccine timing
• There were no timing or treatment modifications to patients being treated with: Sulfasalazine; Leflunomide; Mycophenolate; Azathioprine; Cyclophosphamide (oral); TNFi; IL-6R; IL-1; IL-17; IL-12/23; IL-23; Belimumab; oral calcineurin inhibitors; Glucocorticoids, prednisone-equivalent dose ≥ 20mg/day, Hydroxychloroquine; IVIG; glucocorticoids, prednisone-equivalent dose
• There is a theoretical risk flare for AIIRD patients during the vaccination, however the benefit outweighs risk for RMD patients.
• The guidelines continue to urge rheumatologists to take into consideration the varied disease severity, multimorbidity, and therapies when creating individualized care plans.

Although the data are limited, patients with autoimmune and inflammatory conditions were at both greater risk for developing COVID-19 as well as developing more severe outcomes, such as hospitalization. “Based on this concern, the benefit of COVID-19 vaccination outweighs any small, possible risks for new autoimmune reactions or disease flare after vaccination,” Jeffrey Curtis, MD, MS, MPH, and chair of the ACR COVID-19 Vaccine Clinical Guidance Task Force, said in a statement.

The report underscores, “This guidance is provided as part of a ‘living document,’ recognizing rapidly evolving evidence and the anticipated need for frequent updates as such evidence becomes available.” Experts continue to work tirelessly to stay up to date in this ever-changing environment.

Reference:

COVID-19 Vaccine Clinical Guidance Summary for Patients with Rheumatic and Musculoskeletal Diseases. Rheumatology.com. https://www.rheumatology.org/Portals/0/Files/COVID-19-Vaccine-Clinical-Guidance-Rheumatic-Diseases-Summary.pdf. Published February 11, 2021. Accessed February 16, 2021.