COVID-19 vaccine safety and efficacy in patients with immune-mediated inflammatory disease: Review of available evidence

Abstract

Dermatologists diagnose and treat many immune-mediated inflammatory diseases (IMID). Understanding the inherent immune dysregulation of these diseases as well as the additional disruption that comes as a result of IMID treatments has been important during the COVID-19 pandemic. With vaccines becoming widely available, dermatologists need to be familiar with the risks and benefits of vaccination in these patients, particularly those taking biologics, in order to have informed discussions with their patients. In this review, we present the current evidence related to COVID-19 vaccine safety and efficacy in patients with IMID and review existing recommendations for vaccination against SARS-CoV-2. Given the current evidence, there is minimal concern that these patients are at any greater risk of harm from COVID-19 vaccination compared to healthy controls. For most, the benefit of avoiding severe COVID-19 through vaccination will outweigh the theoretical risk of these vaccines. A question that is still outstanding is whether patients on biologics will generate a sufficient immune response to the vaccine, which may be dependent on the specific biologic therapy and indication being treated. This underscores the importance of following patients with IMID after vaccination to determine the safety, efficacy, and duration of the vaccine in this population.

Real-World Use and Adverse Events of SARS-CoV-2 Vaccination in Greek Patients with Inflammatory Bowel Disease

“…In an attempt to find a possible correlation between the use of biologic agents and occurrence of AEs, we have proceeded to a sub-analysis according to treatment group (biologics, immunomodulators, combination therapy or no immunosuppression). The majority of studies emphasize that patients with immune-mediated inflammatory diseases receiving biologic therapies do not run any extra risk for AEs after COVID-19 vaccination [7][8][9]25,26] when compared with the general population. However, in the recently published PREVENT-COVID study anti-TNFa and vedolizumab use were associated with severe systemic reactions to D2 [10] while there is one report showing that the AE risk might even be reduced while on biologics [7].…”

What Happens to the Immune System after Vaccination or Recovery from COVID-19?

“…Andryukov and Besednova (2021) reviewed strategies and platforms to improve the effectiveness of vaccination in older adults, as they are the most affected and vulnerable people because of immunosenescence and the consequent decrease in the effect of immunization [160]. Another public health concern is immunocompromised and immunemediated inflammatory patients, who deserve special attention after vaccination, generally regarding whether patients on biologics will generate a sufficient immune response to the vaccine [161]. To address this issue, the UK's Joint Committee on Vaccination and Immunisation (JCVI) has recommended that people with severely weakened immune systems should have a third vaccine dose [162].…”

A Web-Based Survey on Factors for Unvaccination and Adverse Reactions of SARS-CoV-2 Vaccines in Chinese Patients with Psoriasis

“…5,6 Although psoriasis is not a contraindication for many vaccinations of infectious diseases, the vaccination rate in patients with psoriasis remains low owing to the concerns about the safety of vaccines and unawareness of the risk of infection. 3,7 Although evidence is limited, some case series recently reported psoriasis flare-up linked to SARS-CoV-2 vaccination. 8,9 However, studies systematically investigated adverse reactions after vaccination for SARS-CoV-2 in psoriatic patients are scarce.…”