The ACR Addresses Vaccine Challenges

When can I get my vaccine? Will the vaccine make me have a flare of my lupus? Which vaccine is going to be best for me? If your practice is like mine, these questions have been occupying your clinic staff ever since the U.S. Food & Drug Administration gave emergency use authorization to the Pfizer and Moderna vaccines for COVID-19.

David R. Karp, MD, PhD

At the beginning of the pandemic last year, the questions surrounding COVID-19 related to whether patients with rheumatic and musculoskeletal diseases would be more susceptible to SARS-CoV-2 or whether their illness would be more severe. In response, the ACR COVID-19 Clinical Guidance task forces published expert opinion, informed by the emerging scientific literature, on the care of both adults and children with autoimmune or autoinflammatory rheumatic diseases who have been exposed to or who have contracted COVID-19. These documents have been revised as new data emerged and have been accessed thousands of times since they appeared on the COVID-19 section of our website.

Now, all of the questions posed by both patients and providers revolve around vaccination. Is it safe for patients with altered immune systems to receive these vaccines, particularly those employing the novel mRNA technology? Will patients who already make their own autoantibodies to nucleic acids or phospholipids have an adverse reaction to a vaccine containing just those two constituents? Could receiving the vaccine exacerbate their underlying disease? Will the vaccine be effective in patients with autoimmune and rheumatic diseases? Will our patients need to hold or modify their disease-modifying anti-rheumatic drug therapies before or after they are vaccinated?

‘Proceeding at our own version of Operation Warp Speed, the task force worked … to craft practical guidance for members. The guidance documents were approved by the ACR Board in early February.’ —Dr. Karp

To provide answers to these and many other questions raised by our members, a COVID-19 Vaccine task force was created last fall, just as the outstanding results of the phase 3 clinical trials were being released. A call for volunteers went out, and Jeff Curtis, MD, University of Alabama at Birmingham, was selected to lead this effort. Members of the task force included other rheumatologists, infectious disease specialists and experts in vaccines.

Proceeding at our own version of Operation Warp Speed, the task force worked through December and January, analyzing the data on the COVID-19 vaccines as well as the literature on other vaccines administered to patients with rheumatic diseases. They used a modified Delphi process to rank 72 statements regarding vaccine safety, efficacy and interaction with medications, and craft practical guidance for members. The guidance documents were approved by the ACR Board in early February.