How Rheumatology Patients Should Be Vaccinated for COVID-19

In early February, the American College of Rheumatology (ACR) announced an updated version of its COVID-19 Vaccine Clinical Guidance for Patients with Rheumatic and Musculoskeletal Diseases.

This update - the fifth of its kind- featured support for booster and supplemental doses in addition to recommendations regarding the timing of the injection as well as immunomodulatory medication use.

Revisions were also made regarding pre- and post-exposure prophylaxis with monoclonal antibody treatment, which are still supported by the guidance despite some limitations being issued by the US Food and Drug Administration.

In a statement made on the day of the announcement, Jeffrey Curtis, MD, MS, MPH, Chair of the ACR COVID-19 Vaccine Guidance Task Force, said that “There is now more nuance with supplemental and booster dose recommendations that should prompt us to ask patients not only whether they have been vaccinated, but with what, how many times, and how recently.”

Curtis sat down with HCPLive to speak of the main updates included in the newest version of the guidance and the implications of these changes for patients with rheumatic disease.

“The main updates included in the version are quite specific to trying to establish the clarity between supplemental and booster doses, te nomenclature was incredibly confusing not just for patients, but it was confusing for clinicians too,” Curtis said. “So, we've tried to harmonize and differentiate what's a supplemental dose, what's the booster dose, and to start moving away from numbering the doses just because that led to a lot of confusion.”

In addition to doing away with the numbering of doses, a more precise scheduling of supplemental and booster doses has been put in place to ensure that patients with rheumatic and musculoskeletal diseases are reaping the benefits of multiple doses.

“Certainly one of the most important messages is that rheumatologists heretofore probably we're just asking patients, have you been vaccinated and with what and hopefully when?” Curtis said. “But now it's gotten more complicated. Now, it's what dose are you on and when were you vaccinated most recently? So, a more careful history about vaccination status is important for clinicians and from a patient's perspective, if you don't know that there might be some important timing considerations, you'll just go out and get the dose that you think you should get.”

Curtis added in some cases the possibility exists where doctors can either hold medications such as rituximab temporarily or space the vaccine throughout a medication cycle so that patients have the best chance of responding to the vaccine.

The revisions to the guidance provided by ACR also apply to patients who were infected with the COVID-19 virus, though some recommendations may vary. Regarding patients who were treated with monoclonal antibodies for their COVID-19 infection, it is recommended that they wait 3 or more months to receive a vaccine dose.

Additionally, the FDA has limited the use of certain monoclonal antibody therapies that have underperformed against Omicron, the current dominant variant.

“As rheumatologists, we need to be querying patients as to how recently they were vaccinated with what in light of their treatments and their disease and their activity,” Curtis said. “Early on, everyone was just in a hurry, get them something even if the vaccine response wasn't great. Now we have a little bit more time to be thoughtful to try to get it right to the extent we know what right looks like.”

To hear more from Dr. Curtis, listen to the full episode of DocTalk above.