JointHealth™ express April 27, 2021
Important Saskatchewan 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:
As part of its Phase 2 delivery of the COVID-19 vaccination, the Saskatchewan government has begun sending letters to people with underlying health conditions that are extremely clinically extremely vulnerable, including people on immunosuppression therapies sufficient to significantly increase risk of infection (e.g. biologic modifiers).
Individuals who are clinically extremely vulnerable will receive a letter from the Saskatchewan government notifying them of their eligibility for the COVID-19 vaccine.
You are encouraged to book online when you are eligible. The online tool is simple, fast and easy to use. It takes just a few minutes to book your appointment. The system will guide you through a few simple questions, gathering consent, choice of clinic and booking date and time. To use the online booking option you must have a valid health card, cell phone and/or email address. By booking online you will have faster access to book your appointment.
There is also a phone-in option if you require assistance. Here's what happens when you call:
Important Saskatchewan 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, Riximyo, Ruxience, 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.
As part of its Phase 2 delivery of the COVID-19 vaccination, the Saskatchewan government has begun sending letters to people with underlying health conditions that are extremely clinically extremely vulnerable, including people on immunosuppression therapies sufficient to significantly increase risk of infection (e.g. biologic modifiers).
Individuals who are clinically extremely vulnerable will receive a letter from the Saskatchewan government notifying them of their eligibility for the COVID-19 vaccine.
You are encouraged to book online when you are eligible. The online tool is simple, fast and easy to use. It takes just a few minutes to book your appointment. The system will guide you through a few simple questions, gathering consent, choice of clinic and booking date and time. To use the online booking option you must have a valid health card, cell phone and/or email address. By booking online you will have faster access to book your appointment.
There is also a phone-in option if you require assistance. Here's what happens when you call:
- The phone agent verifies your age and asks for your personal information noted above.
- If you are calling on behalf of someone else, the phone agent verifies who you are calling for and asks you to provide their age and personal information.
- You work with the phone agent to select an appointment time slot at a clinic in your desired location.
- The phone agent confirms your appointment time and clinic location.
- If you've provided contact information, you get a confirmation message sent by email or text.
Arthritis Consumer Experts
ACE thanks Arthritis Research Canada (ARC) for its scientific review of ACE and JointHealth™ information and education programs.