JointHealth™ express April 7, 2021
Important Ontario Patient Information about the COVID-19 vaccination for people with inflammatory (or “autoimmune”) arthritis and on immunosuppression therapies
Although there is limited data from large population-based studies, it appears that patients with autoimmune and inflammatory diseases and conditions (such as rheumatoid arthritis, axial spondyloarthritis and lupus) are at a higher risk for developing COVID-19 that result in hospitalization compared to the general population. They also can have worse outcomes associated with the infection, most notably, an increased risk of death especially in those with poorly controlled disease and underlying complications related to their disease.
People living with forms of inflammatory arthritis have questions and concerns on whether they should take the COVID-19 vaccine. The Canadian Rheumatology Association and the American College of Rheumatology have published evidence-based recommendations that the benefit of COVID-19 vaccination outweighs any small, possible risks for new autoimmune reactions or disease flare after vaccination, as well as advice on how to best include it into their treatment plans to maximize vaccine efficacy.
Here are the recommendations:
The Ontario government announced on April 6, 2021 it is moving into Phase Two of its COVID-19 vaccine distribution plan. During Phase Two, the following groups will be eligible for vaccination:
Patients with immune deficiencies / autoimmune disorders and immunocompromising health conditions are listed in the “at-risk” category.
For up-to-date information on the populations currently eligible for vaccination and instructions on how to book an appointment when you are eligible, visit Ontario’s vaccine webpage.
Eligible individuals can schedule a vaccine appointment by visiting Ontario.ca/bookvaccine, or by calling the Provincial Vaccine Booking Line number at 1-833-943-3900.
Individuals aged 55 and over can visit ontario.ca/pharmacycovidvaccine to find a participating pharmacy and can contact the pharmacy to make an appointment for COVID-19 vaccination.
For resources in multiple languages to help local communication efforts in responding to COVID-19, visit Ontario’s COVID-19 communication resources webpage.
Visit Ontario’s website to learn more about how the province continues to protect the people of Ontario from COVID-19.
Important Ontario Patient Information about the COVID-19 vaccination for people with inflammatory (or “autoimmune”) arthritis and on immunosuppression therapies
Although there is limited data from large population-based studies, it appears that patients with autoimmune and inflammatory diseases and conditions (such as rheumatoid arthritis, axial spondyloarthritis and lupus) are at a higher risk for developing COVID-19 that result in hospitalization compared to the general population. They also can have worse outcomes associated with the infection, most notably, an increased risk of death especially in those with poorly controlled disease and underlying complications related to their disease.
People living with forms of inflammatory arthritis have questions and concerns on whether they should take the COVID-19 vaccine. The Canadian Rheumatology Association and the American College of Rheumatology have published evidence-based recommendations that the benefit of COVID-19 vaccination outweighs any small, possible risks for new autoimmune reactions or disease flare after vaccination, as well as advice on how to best include it into their treatment plans to maximize vaccine efficacy.
Here are the recommendations:
- All adult inflammatory arthritis patients should receive the COVID-19 vaccine unless there are known allergies to vaccine components. Patients on immune suppressing medications (such as those listed below) should receive the vaccine. The CRA does not recommend adjusting these medications; however, in individual cases, medication adjustment may be appropriate.
- There is no preference for one manufacturers’ vaccine over another.
- For inflammatory arthritis patients on the following medications, there is no need to adjust or delay the medication:
- Anti-inflammatory medications (or “NSAIDs”)
- Hydroxychloroquine (Plaquenil)
- Prednisone less than 20mg/day
- IVIG
- Sulfasalazine
- Leflunomide (Arava)
- Mycophenolate (CellCept)
- Azathioprine
- Oral cyclophosphamide
- Cyclosporin
- Tacrolimus (Protopic)
- Anakinra (Kineret)
- Etanercept (Enbrel, Brenzys, Erelzi)
- Infliximab (Avsola, Inflectra, Remicade, Renflexis)
- Certolizumab (Cimzia)
- Golimumab (Simponi)
- Adalimumab (Humira)
- Secukinumab (Cosentyx)
- Ustekinumab (Stelara)
- Sarilumab (Kevzara)
- Tocilizumab (Actemra)
- Belimumab (Benlysta)
- Ixekizumab (Taltz)
- For patients on the following medications, there are two options:
Option 1:
Do not change medication dosing (Canadian Guidelines).
Option 2:
Adjust medication dosing to optimize the immune response to the vaccine (American Guidelines). For this option, the guidelines make the following medication specific recommendations:- For patients on weekly methotrexate, an option is to skip the MTX dose the following week after each vaccine dose.
- For patients on tofacitinib, baricitinib, upadacitinib, an option is to skip the medication for 1 week following each vaccine dose.
- For patients on abatacept weekly injections, an option is to skip the abatacept one week before and one week after the first dose of vaccine. Continue abatacept through the second dose of vaccine. For IV abatacept, consider timing the 1st dose of vaccine 4 weeks post dose and postpone next infusion x 1 week. No IV Abatacept adjustments needed for 2nd vaccine dose.
- For patients on IV cyclophosphamide, an option is to take each vaccine dose at least 1 week prior to the next cyclophosphamide infusion.
- For patients on rituximab (Rituxan, Ruxience, Riximyo, Truxima) or
ocrelizumab , the COVID-19 vaccination should ideally be timed 4-5 months after your last infusion and 2-4 weeks prior to their next infusion, when possible, in order to optimize vaccine response. However, in patients who require immediate infusion or who are unable to optimize timing of infusion product and vaccine, it is likely more important to have the COVID vaccine earlier than to delay based on timing of B-cell therapy. - For patients on prednisone 20mg/d or higher, consider waiting until the prednisone dose is tapered to below 20mg/d to receive both vaccine doses.
The Ontario government announced on April 6, 2021 it is moving into Phase Two of its COVID-19 vaccine distribution plan. During Phase Two, the following groups will be eligible for vaccination:
- Older adults, between 60-79 years of age;
- Individuals with specific health conditions and some primary caregivers;
- People who live and work in congregate settings and some primary caregivers;
- People who live in hot spots with high rates of death, hospitalizations and transmission; and,
- Certain workers who cannot work from home.
Patients with immune deficiencies / autoimmune disorders and immunocompromising health conditions are listed in the “at-risk” category.
For up-to-date information on the populations currently eligible for vaccination and instructions on how to book an appointment when you are eligible, visit Ontario’s vaccine webpage.
Eligible individuals can schedule a vaccine appointment by visiting Ontario.ca/bookvaccine, or by calling the Provincial Vaccine Booking Line number at 1-833-943-3900.
Individuals aged 55 and over can visit ontario.ca/pharmacycovidvaccine to find a participating pharmacy and can contact the pharmacy to make an appointment for COVID-19 vaccination.
For resources in multiple languages to help local communication efforts in responding to COVID-19, visit Ontario’s COVID-19 communication resources webpage.
Visit Ontario’s website to learn more about how the province continues to protect the people of Ontario from COVID-19.
Arthritis Consumer Experts
ACE thanks Arthritis Research Canada (ARC) for its scientific review of ACE and JointHealth™ information and education programs.