WASHINGTON, D.C.—People with rheumatic diseases should be considered for flu and pneumococcal vaccines—but generally not live vaccines—even if they are on immunosuppressive drugs, an expert said during a session titled, “Immunizations in Patients with Rheumatologic Disease,” here at the 2012 ACR/ARHP Annual Meeting, held November 9–14. [Editor’s Note: This session was recorded and is available via ACR SessionSelect at www.rheumatology.org.]
Explore this issueFebruary 2013
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But since immunosuppression can impair the response to these vaccines—and evidence suggests that methotrexate may be more to blame than antitumor necrosis factor therapies alone—getting patients vaccinated early on is the best course, said Gil Melmed, MD, MS, director of clinical trials at the Inflammatory Bowel Disease Center at Cedars-Sinai Medical Center in Los Angeles.
“In our diseases that we treat, immunosuppression is unpredictable,” he said, referring to autoimmune disorders. “Somebody may not be on immunosuppression now, but they may require immunosuppression tomorrow. So we have them here today, let’s take advantage of the opportunity to educate them and administer the vaccines that they should get… They may actually respond less robustly tomorrow after they are on that immunosuppressive therapy.”
Taking on an Internist Role
Rheumatologists may need to assume the role of an internist, including advising patients on getting vaccines, he said. “There are many healthcare maintenance issues that we need to think about that may not necessarily be addressed appropriately by primary care providers who usually take care of healthcare maintenance,” Dr. Melmed said.