COVID-19 VACCINE RECOMMENDATIONS

Dear patients,

Last week the American College of Rheumatology released new guidelines to help physicians and patients navigate the Covid vaccines and their medications for autoimmune diseases.

Here is a list of recommendations, which may help guide you. If you have any further questions, please reach out to our office.

  1. MEDICATIONS THAT DO NOT REQUIRE ANY CHANGE TO THE MEDICATION OR VACCINE TIMING (no need to stop the medicine, proceed with vaccination)

Hydroxychloroquine (Plaquenil);

IVIG;

Glucocorticoids, prednisone-equivalent dose <20mg/day:

Sulfasalazine (Azulfidine);

Leflunomide (Arava);

Mycophenolate (Cellcept);

Azathioprine (Imuran);

Cyclophosphamide (Cytoxan – oral);

TNFi (Remicade, Inflectra, Renflexis, Avsola, Humira, Enbrel, Cimzia, Simponi, Simponi Aria);

IL-6R (Actemra, Kevzara);

IL-1i (Kineret);

IL-17 I (Cosentyx, Taltz);

IL-12/23i (Stelara);

IL-23i (Tremfya);

Belimumab (Benlysta);

oral calcineurin inhibitors (Cyclosporin, Tacrolimus, Pimecrolimus)

Glucocorticoids, prednisone-equivalent-dose≥ 20mg/day**

  1. MEDICATIONS THAT SHOULD BE HELD FOR ONE WEEK AFTER THE VACCINE DOSE:

  1. Methotrexate

Hold MTX 1 week after each vaccine dose, for those with well-controlled disease; no modifications to vaccination timing

***For patients with very active disease, please contact your doctor for guidance.

  1. Abatacept (Orencia) SC (weekly shots given at home)

Hold SQ abatacept both one week prior to and one week after the first COVID-19 vaccine dose (only); no interruption around the second vaccine dose

  1. Abatacept (Orencia) IV (in-office infusion)

Time vaccine administration so that the first vaccination will occur four weeks after abatacept infusion (i.e., the entire dosing interval), and postpone the subsequent abatacept infusion by one week (i.e., a 5-week gap in total); no medication adjustment for the second vaccine dose

  1. Cyclophosphamide  (Cytoxan) IV infusion

Time Cyclophosphamide administration so that it will occur approximately 1 week after each vaccine dose, when feasible

  1. RITUXIMAB (Rituxan) IV infusion

Assuming that patient’s COVID-19 risk is low or is able to be mitigated by preventive health measures (e.g., self-isolation), schedule vaccination so that the vaccine series is initiated approximately 4 weeks prior to next scheduled rituximab cycle; after vaccination, delay RTX 2-4 weeks after 2nd vaccine dose, if disease activity allows.