American College of Rheumatology Guidance for COVID-19 Vaccination in Patients With Rheumatic and Musculoskeletal
Jeffrey R Curtis1, Sindhu R Johnson2, Donald D Anthony3
1University of Alabama at Birmingham.
Insights
This study offers guidance for rheumatology providers on using coronavirus disease 2019 (COVID-19) vaccines in patients with rheumatic and musculoskeletal diseases (RMDs). It provides 74 consensus-based statements to aid vaccination strategies despite limited direct evidence.
Area of Science:
- Rheumatology
- Immunology
- Vaccinology
- Public Health
Background:
- Rheumatic and Musculoskeletal Diseases (RMDs) affect immune system regulation.
- Patients with RMDs may have altered responses to vaccines.
- Coronavirus disease 2019 (COVID-19) vaccination is crucial for this population.
Purpose of the Study:
- To develop evidence-based guidance for rheumatology providers on COVID-19 vaccination in RMD patients.
- To provide recommendations on the use and timing of immunomodulatory therapies around vaccination.
- To facilitate the implementation of effective vaccination strategies for RMD patients.
Main Methods:
- A multidisciplinary task force (rheumatologists, immunologists, infectious disease specialists, public health physicians) was convened.
- A modified Delphi process and RAND/UCLA Appropriateness Method were used to develop consensus statements.
- An evidence report summarizing literature on COVID-19 vaccine efficacy/safety in RMDs and other vaccine data was created.
Main Results:
- Despite limited direct evidence, 74 draft guidance statements were developed.
- Consensus was reached on statements addressing COVID-19 vaccine use in RMD patients.
- Recommendations were formulated regarding immunomodulatory therapy timing relative to vaccination.
Conclusions:
- The guidance statements offer direction for rheumatology health care providers.
- These recommendations aim to optimize COVID-19 vaccine use and strategies for RMD patients.
- The guidance is intended to support informed decision-making in clinical practice.
Objective:
To provide guidance to rheumatology providers on the use of coronavirus disease 2019 (COVID-19) vaccines for patients with rheumatic and musculoskeletal diseases (RMDs).
Methods:
A task force was assembled that included 9 rheumatologists/immunologists, 2 infectious disease specialists, and 2 public health physicians. After agreeing on scoping questions, an evidence report was created that summarized the published literature and publicly available data regarding COVID-19 vaccine efficacy and safety, as well as literature for other vaccines in RMD patients. Task force members rated their agreement with draft consensus statements on a 9-point numerical scoring system, using a modified Delphi process and the RAND/University of California Los Angeles Appropriateness Method, with refinement and iteration over 2 sessions. Consensus was determined based on the distribution of ratings.
Results:
Despite a paucity of direct evidence, 74 draft guidance statements were developed by the task force and agreed upon with consensus to provide guidance for use of the COVID-19 vaccines in RMD patients and to offer recommendations regarding the use and timing of immunomodulatory therapies around the time of vaccination.
Conclusion:
These guidance statements, made in the context of limited clinical data, are intended to provide direction to rheumatology health care providers on how to best use COVID-19 vaccines and to facilitate implementation of vaccination strategies for RMD patients.
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