How rheumatological patients should be vaccinated against COVID-19
How rheumatological patients should be vaccinated against COVID-19

How rheumatological patients should be vaccinated against COVID-19

In early February, American College of Rheumatology (ACR) announced an updated version of it COVID-19 vaccine clinical guide for patients with rheumatic diseases and musculoskeletal disorders.

This update – the fifth of its kind – included support for booster and supplemental doses in addition to recommendations regarding the time of injection as well as immunomodulatory medication use.

Revisions were also made regarding pre- and post-exposure prophylaxis with monoclonal antibody therapy, which is still supported by the guidelines despite some restrictions issued by the US Food and Drug Administration.

In a statement on the day of the announcement, Jeffrey Curtis, MD, MS, MPH, Chair of the ACR COVID-19 Vaccine Guidance Task Force, said that ” only if they have been vaccinated, but with what, how many times and where recently. “

Curtis sat down with HCPLive to talk about the most important updates included in the latest version of the guide and the implications of these changes for patients with rheumatic disease.

“The major updates included in the version are quite specific in trying to establish the clarity between supplemental and booster doses; the nomenclature was incredibly confusing not only for patients, but it was also confusing for clinicians,” Curtis said. “So we’ve been trying to harmonize and differentiate what’s a supplemental dose, what’s a booster dose, and to start moving away from numbering the doses just because it led to a lot of confusion.”

In addition to eliminating the numbering of doses, a more precise planning of supplemental and booster doses has been introduced to ensure that patients with rheumatic and musculoskeletal diseases reap the benefits of multiple doses.

“Surely one of the most important messages is that rheumatologists so far are probably just asking patients, have you been vaccinated and with what and hopefully when?” said Curtis. “But now it has become more complicated. Now what is the dose you are getting and when was the last time you were vaccinated? So a more careful history of vaccination status is important for clinicians, and from a patient’s perspective, if you do not know that there may be some important timing considerations, you will just go out and get the dose you think you should get. . “

Curtis added in some cases that there is a possibility that doctors may either keep medications like rituximab temporarily or place the vaccine through a medication cycle so patients have the best chance of responding to the vaccine.

The revisions of the ACR guidelines also apply to patients who were infected with the COVID-19 virus, although some recommendations may vary. For patients treated with monoclonal antibodies for their COVID-19 infection, it is recommended that they wait 3 or more months to receive a vaccine dose.

In addition, the FDA has restricted the use of certain monoclonal antibody therapies that have underperformed against Omicron, the current dominant variant.

“As rheumatologists, we need to ask patients how recently they were vaccinated with what in light of their treatments and their disease and their activity,” Curtis said. “Early on, everyone was just busy, getting them something, even though the vaccine response was not great. Now we have a little more time to be thoughtful about trying to get it right to the extent that we know what the right looks like.”

To hear more from Dr. Curtis, listen to the full section of DocTalk above.

Leave a Reply

Your email address will not be published.