Caution & Compliance
Although we don’t have the full picture about the efficacy of these vaccines in rheumatic patients, clinicians should continue to encourage their patients to receive vaccinations in a timely manner.
Physician education can play an important role here. Live vaccines are generally contraindicated in patients taking certain immunosuppressants. Dr. Paik notes that some of her patients on immunosuppressants have been hesitant to get vaccinated because of previous discussions about avoiding live vaccines. “Sometimes, there is a disconnect; even though this mRNA vaccine is not a live vaccine, they get nervous,” she says.
Regarding patients’ potential vaccine hesitancy, Dr. Calabrese also urges, “Taking a moment to address concerns, recommend the vaccines and answer questions can really increase vaccine uptake.”
Dr. Segev also thinks it is important that patients on immunosuppression therapies understand that being vaccinated may not necessarily entail immunity, especially for people taking more extreme levels of immunosuppression. The Centers for Disease Control and Prevention (CDC) currently states that most fully vaccinated people no longer need to wear a mask or physically distance in any setting (except as mandated by local regulations or workplace policies).13 Yet this may not be as safe for an immunosuppressed person as it would be for a person who is immunocompetent.
In fact, these same recommendations note that people on immunosuppressive mediations should discuss their need for personal protective measures after vaccination with their healthcare provider. However, patients may miss this nuance in the headlines. Until we have the more definitive data about vaccine response in rheumatic patients that will emerge over the next several months, it may be wise for physicians to urge continued caution for their patients.
Ruth Jessen Hickman, MD, is a graduate of the Indiana University School of Medicine. She is a freelance medical and science writer living in Bloomington, Ind.
Breaking News
Since this article was initially written, Dr. Paik et al. have published the results from their second study, analyzing antibody responses about four weeks after two doses of mRNA vaccine in 404 rheumatic patients. Inflammatory arthritis and lupus were the first and second most common diagnoses, respectively.
Anti-SARS-CoV-2 antibodies were positive in 94% of participants overall, with lower response rates and lower antibody titers in those on regimens including mycophenolate or rituximab. Of patients on TNF inhibitors, 100% were antibody positive; all eight patients on glucocorticoid monotherapy had robust antibody levels.
Source: Ruddy JA, Connolly CM, Boyarsky BJ, et al. High antibody response to two-dose SARS-Co-V-2 messenger RNA vaccination in patients with rheumatic and musculoskeletal disease. Ann Rheum Dis.
