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Interleukin-1 Inhibitors and Vaccination Including COVID-19 in Inflammatory Rheumatic Diseases: A Nonsystematic

Pamir Atagündüz1, Gökhan Keser2, Mehmet Soy3

  • 1Department of Rheumatology, School of Medicine, Marmara University, Istanbul, Turkey.

Frontiers in Immunology
|February 14, 2022
PubMed

Insights

COVID-19 vaccination is crucial for patients with autoimmune/autoinflammatory rheumatic diseases (AIIRD). For those on Interleukin-1 (IL-1) blockers, vaccination can often proceed without therapy interruption, especially with high disease activity.

Area of Science:

  • Rheumatology and Immunology
  • Infectious Disease Epidemiology
  • Vaccinology

Background:

  • Emerging SARS-CoV-2 variants and rising COVID-19 cases present ongoing global health challenges.
  • Patients with autoimmune/autoinflammatory rheumatic diseases (AIIRD) face a more severe prognosis for COVID-19 compared to the general population.
  • COVID-19 vaccination is essential for AIIRD patients, but the impact of Interleukin-1 (IL-1) blockade on vaccine response requires further clarification.

Purpose of the Study:

  • To review the current literature regarding the timing of COVID-19 vaccination in AIIRD patients receiving IL-1 blocking therapies.
  • To provide guidance on optimizing vaccine response while managing AIIRD activity and preventing relapses.

Main Methods:

  • Literature review of existing evidence on COVID-19 vaccination efficacy and safety in immunosuppressed AIIRD patients.
  • Analysis of expert opinions and recommendations concerning the timing of vaccination relative to IL-1 inhibitor therapy.
  • Consideration of factors such as drug half-life, disease activity, and relapse risk in vaccination timing strategies.

Main Results:

  • Moderate agreement exists on the optimal timing of COVID-19 vaccination for patients on IL-1 blockers, with varying expert opinions.
  • Generally, vaccination without interrupting IL-1 blockade is recommended, particularly for patients with high disease activity, to prevent flares.
  • In specific cases, especially with long half-life IL-1 inhibitors (e.g., canakinumab, rilonacept), vaccination may be considered seven days after drug levels normalize, balancing disease activity and relapse risk.

Conclusions:

  • COVID-19 vaccination is paramount for AIIRD patients due to their increased risk of severe disease.
  • While continuous IL-1 blockade is often feasible during vaccination, individualized assessment considering disease activity and drug properties is crucial.
  • Strategic vaccination timing can help ensure an adequate immune response, mitigating the risk of severe COVID-19 in this vulnerable population.
Keywords:
COVID-19IL-1autoimmune/autoinflammatory rheumatic diseasesinterleukin-1 inhibitorsvaccination

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