American College of Rheumatology Announces COVID-19 Clinical Guidance Summary

The American College of Rheumatology (ACR) is a prominent organization that provides expert guidance on the diagnosis and treatment of rheumatic conditions. Their annual meeting has over 15,000 clinicians from around the world in attendance. This week they held a town hall virtual meeting to discuss their recommendations regarding COVID-19 vaccination and how it should be managed in patients who have rheumatic diseases.

As stated in previous blog posts, the main message is that although patients who have autoimmune diseases and are on medications that may suppress the immune system, and as such, may have somewhat less of a response to the COVID-19 vaccines or even have a short-term flare of their inflammatory condition, getting the vaccine is highly suggested and is of less risk to patients than not being vaccinated.

Their summary document can be found here.

In Table 3 of this document, there are suggestions as to which treatments could be held for a short period of time after the vaccine to help increase the vaccine benefit. Holding any dose of medication when getting a vaccine is only suggested for patients who are stable and not flaring.

Here are some of the highlights of this guidance:

Methotrexate – consider holding one dose the week after each of the COVID-19 vaccines.
JAK inhibitors includes: Xeljanz (tofacitinib), Olumiant (Baricitinib) and Rinvoq (upadacitinib)- hold tablets for 1 week after each vaccine dose.
Abatacept (Orencia) is given by weekly injection or an infusion. If you receive the injection, hold the dose the week before and the week after the first dose of COVID vaccine but not for the second vaccine dose. For those on IV Orencia, when your next dose is due at 4 weeks, receive the first COVID vaccine, wait 1 week and then resume treatment (no holding of dose for the second vaccine).
Rituximab (Rituxan, Ruxience, Riximyo, Truxima) can significantly blunt vaccine benefit in general. Ideally wait until 4 weeks before your next rituximab dose to get your first vaccine and then wait 2-4 weeks after the second vaccine before resuming rituximab treatment.
NO holding of any doses is required for the majority of treatments, including: sulfasalazine, leflunomide, hydroxychloroquine, prednisone under 20mg/day, azathioprine, IVIG, mycophenolate, belimumab, cyclophosphamide tablets and the following biologic groups of medications: (anti-TNF, anti-IL-6R, anti- IL-12/23, anti-IL-23, anti-IL-1) do not require any doses to be held at the time of receiving the COVID vaccines

As always, these suggestions are based on expert opinion and do not replace the individual advice of your specialist.

Carolyn Whiskin is the Pharmacy Manager for Charlton Health. Carolyn specializes in the treatment of autoimmune diseases, pharmaceutical compounding, women’s health, pain and smoking cessation. Carolyn has won provincial and national awards for her commitment to patient care and public service.

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