COVID-19 vaccination and antirheumatic therapy

Area of Science:

• Immunology
• Rheumatology
• Vaccinology

Background:

• The COVID-19 vaccination program is the largest in NHS history, prioritizing patients on immunosuppressive therapy.
• Existing data suggest immunosuppressive therapies can impair humoral responses to other vaccines like influenza and hepatitis B.
• The impact of immunosuppression on COVID-19 vaccine efficacy in patients with inflammatory arthritis is not yet fully understood.

Purpose of the Study:

• To review current evidence on the effects of antirheumatic therapies on vaccine responses.
• To formulate a pragmatic management strategy for COVID-19 vaccination in patients with inflammatory arthritis on immunosuppressants.

Main Methods:

• Literature review of studies investigating immunosuppressive therapy and vaccine responses.
• Analysis of data on specific immunosuppressants (e.g., methotrexate, rituximab) and their impact on humoral immunity.
• Synthesis of findings to propose a clinical management approach.

Main Results:

• Some immunosuppressive therapies may reduce vaccine response, while others, like rituximab, can impair responses for extended periods.
• Withholding methotrexate for two weeks post-vaccination may enhance immune response.
• Data on COVID-19 specific vaccine responses in this population are limited.

Conclusions:

• Decisions regarding immunosuppressive therapy interruption for COVID-19 vaccination require careful consideration due to limited specific data.
• A pragmatic management strategy is proposed to optimize COVID-19 vaccine effectiveness in patients with inflammatory arthritis.
• Further research is needed to fully elucidate COVID-19 vaccine responses in patients on immunosuppressive therapy.