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Guidelines on COVID-19 vaccination in patients with immune-mediated rheumatic diseases: a Brazilian Society of
Anna Carolina Faria Moreira Gomes Tavares1, Ana Karla Guedes de Melo2, Vítor Alves Cruz3
1Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
Insights
This study provides guidelines for coronavirus disease 2019 (COVID-19) vaccination in patients with immune-mediated rheumatic diseases (IMRD). Developed by experts, these guidelines aid rheumatologists in making shared decisions about optimal COVID-19 vaccine timing for IMRD patients.
Area of Science:
- Rheumatology
- Immunology
- Infectious Diseases
Background:
- Patients with immune-mediated rheumatic diseases (IMRD) often require special considerations for vaccination.
- Guidelines are needed to address the optimal timing and approach for COVID-19 vaccination in IMRD patients.
Purpose of the Study:
- To develop evidence-based guidelines for COVID-19 vaccination in patients with IMRD.
- To support rheumatologists in shared decision-making regarding vaccine administration.
- To optimize vaccine response in IMRD patients during the COVID-19 pandemic.
Main Methods:
- A task force of 24 rheumatologists developed guidelines using the Delphi method.
- Four rounds of anonymous voting determined the level of agreement on 19 key questions.
- A literature search identified relevant studies on COVID-19 vaccines in immunocompromised patients.
Main Results:
- Consensus was reached on 19 questions regarding COVID-19 vaccination for IMRD patients.
- Over 80% of panelists agreed on the formulated answers, indicating high consensus.
- Guidelines focus on the appropriate timing for vaccination to ensure adequate immune response.
Conclusions:
- The developed guidelines offer expert consensus for COVID-19 vaccination in IMRD patients.
- These recommendations are based on literature review and expert opinion.
- Clinical judgment remains essential, as high-quality evidence was limited during the pandemic.
Objective:
To provide guidelines on the coronavirus disease 2019 (COVID-19) vaccination in patients with immune-mediated rheumatic diseases (IMRD) to rheumatologists considering specific scenarios of the daily practice based on the shared-making decision (SMD) process.
Methods:
A task force was constituted by 24 rheumatologists (panel members), with clinical and research expertise in immunizations and infectious diseases in immunocompromised patients, endorsed by the Brazilian Society of Rheumatology (BSR), to develop guidelines for COVID-19 vaccination in patients with IMRD. A consensus was built through the Delphi method and involved four rounds of anonymous voting, where five options were used to determine the level of agreement (LOA), based on the Likert Scale: (1) strongly disagree; (2) disagree, (3) neither agree nor disagree (neutral); (4) agree; and (5) strongly agree. Nineteen questions were addressed and discussed via teleconference to formulate the answers. In order to identify the relevant data on COVID-19 vaccines, a search with standardized descriptors and synonyms was performed on September 10th, 2021, of the MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, and LILACS to identify studies of interest. We used the Newcastle-Ottawa Scale to assess the quality of nonrandomized studies.
Results:
All the nineteen questions-answers (Q&A) were approved by the BSR Task Force with more than 80% of panelists voting options 4-agree-and 5-strongly agree-, and a consensus was reached. These Guidelines were focused in SMD on the most appropriate timing for IMRD patients to get vaccinated to reach the adequate covid-19 vaccination response.
Conclusion:
These guidelines were developed by a BSR Task Force with a high LOA among panelists, based on the literature review of published studies and expert opinion for COVID-19 vaccination in IMRD patients. Noteworthy, in the pandemic period, up to the time of the review and the consensus process for this document, high-quality evidence was scarce. Thus, it is not a substitute for clinical judgment.
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