American College of Rheumatology Guidance for COVID‐19 Vaccination in Patients With Rheumatic and Musculoskeletal Diseases: Version 5

Abstract

Objective To provide guidance to rheumatology providers on the use of COVID‐19 vaccines for patients with rheumatic and musculoskeletal diseases (RMDs). Methods A task force was assembled that included 9 rheumatologists/immunologists, 2 infectious diseases specialists, and 2 public health physicians. After agreeing on scoping questions, an evidence report was created that summarized the published literature and publicly available data regarding COVID‐19 vaccine efficacy and safety, as well as literature for other vaccines in RMD patients. Task force members rated their agreement with draft consensus statements on a 9‐point numerical scoring system, using a modified Delphi process and the RAND/University of California Los Angeles Appropriateness Method, with refinement and iteration over 2 sessions. Consensus was determined based on the distribution of ratings. Results Despite a paucity of direct evidence, statements were developed by the task force and agreed upon with consensus to provide guidance for use of the COVID‐19 vaccines, including supplemental/booster dosing, in RMD patients and to offer recommendations regarding the use and timing of immunomodulatory therapies around the time of vaccination. Conclusion These guidance statements are intended to provide direction to rheumatology health care providers on how to best use COVID‐19 vaccines and to facilitate implementation of vaccination strategies for RMD patients.

The kinetics of humoral and cellular responses after the booster dose of COVID-19 vaccine in inflammatory arthritis patients

“…The faster decline of the immune response compared to HC after the booster dose indicates the need for more frequent booster vaccinations in patients with IA than in HC. This is in line with the ACR recommendations, which, based on Centers for Disease Control and Prevention recommendations for non-immunocompetent people, currently recommends vaccinating patients with rheumatic diseases with 5 doses of the COVID-19 vaccine in total (14).…”

The Kinetics of Humoral and Cellular Responses after the Booster Dose of COVID-19 Vaccine in Inflammatory Arthritis Patients

“…The faster decline of the immune response compared to HC after the booster dose indicates the need for more frequent booster vaccinations in patients with IA than in HC. This is in line with the ACR recommendations, which, based on Centers for Disease Control and Prevention recommendations for non-immunocompetent people, currently recommends vaccinating patients with rheumatic diseases with 5 doses of the COVID-19 vaccine in total [ 39 ].…”

Navigating use of rituximab during the COVID-19 pandemic

“…The importance of timing between vaccination and anti-CD20 therapies has been shown in several other studies and is supported by current society guidelines. 7 In the study by Md Yusof and colleagues, 5 a low proportion of patients had absent or low B cells before rituximab treatment but, as expected, most patients with available samples had complete CD20 + cell depletion after rituximab treatment. These observations reflect the practices of rituximab use in the single study centre, where rituximab redosing in patients with systemic lupus erythematosus and rheumatoid arthritis (the most common diagnoses in the study population) was guided by clinical relapses rather than by fixed interval.…”

“…The study results further support the current recommendations regarding timing of vaccination and anti-CD20 therapies. 7 With ongoing concerns over possible reduced efficacy of tixagevimab–cilgavimab against emerging SARS-CoV-2 variants and challenges in accessing this drug combination, securing vaccination in high-risk individuals, such as those on anti-CD20 therapies, remains vital.…”