COVID-19 and Vaccine Information
Should people with rheumatic diseases or whom take immunosuppressives get the COVID Vaccine?
The US Food and Drug Administration has authorized three vaccines for prevention of COVID-19: Pfizer, Moderna and Johnson & Johnson. There is no ‘best’ vaccine. None of them are considered “live” and will not cause infection. We recommend either Pfizer or Moderna as rare severe strokes have been seen in women aged 18-45 yo with the J&J vacccine. Other than the generally expected mild/moderate side effects reported from a vaccine, there are no other expected problems from the Prizer or Moderna vaccines when given to rheumatology patients. We believe the benefit of the vaccine to prevent severe disease/death, far outweighs any risk. Please refer to the ACR guide for holding or timing of meds if applicable – these are summarized in the table below.
Click to read the most recent CDC updates.
Click to read the CDC Update for High Risk Groups which includes persons including RA, lupus, scleroderma, vasculitis and others treated with immunosuppressive medications.
The American College of Rheumatology published guidance on whether there is a need to adjust the timing of specific anti-rheumatic drugs when one receives the COVID-19 vaccine. See the summary below.
| Medication | Medication Administration Time Consideration and Vaccination |
| Prednisone < 20 mg/day | No modification to medication dosing or vaccine timing needed. |
| Hydroxychloroquine Apremilast (Otezla) Sulfasalazine Leflunomide (Arava) Azathioprine (Imuran) Mycophenolate (Cellcept) | No modification to medication dosing or vaccine timing needed. |
| Methotrexate | Hold methotrexate for 1 week after vaccine dose. No modification to vaccine timing. |
| Calcineurin Inhibitors · Tacrolimus (Prograf) · Cyclosporine A (Neoral) · Voclosporin (Lupkynis) | No modification to medication dosing or vaccine timing needed. |
| TNF blockers · Etanercept (Enbrel) · Adalimumab (Humira) · Infliximab (Remicade) · Golimumab (Simponi) · Certolizumab (Cimzia) T Cell blocker · Abatacept (Orencia) IL-1 blockers · Anakinra (Kineret)1 · Canakinumab (Ilaris) IL-6 blockers · Tocilizumab (Actemra) · Sarilumab (Kevzara) B Cell blocker · Belimumab (Benlysta) IL-17 blockers · Secukinumab (Cosentyx) · Ixekizumab (Talz) · Brodalumab (Siliq) IL-23 blockers · Guselkumab (Tremfya) · Risankizumab (Skyrizi) IL-12/23 blocker · Usekinumab (Stelara) | No modification to medication dosing or vaccine timing needed. |
| Janus Kinase Inhibitor (JAKi) · Tofacitinib (Xeljanz) · Baricitinib (Olumiant) · Upadacitinib (Rinvoq) | Hold JAKi for 1 week after vaccine dose. No modification to vaccine timing. |
| Rituximab (Rituxan) | # see below |
| Abatacept (Orencia) | * see below. |
# Rituximab: 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.
*Abatacept: SQ abatacept one week prior to and one week after the first COVID-19 vaccine dose (only); no interruption around the second vaccine dose.
*Abatacept: 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.
We are receiving questions from our patients whether it is useful to test if they developed protective antibodies after taking a COVID-19 vaccine. None of the currently authorized tests have been specifically authorized to assess individuals who have received the vaccine. There is no established protocol or payment mechanism for standard SARS-CoV-2 antibody testing at this time, which means it is possible ‘non-indicated’ testing of this type may not be covered by insurance. Click to read the CDC Guidelines on COVID-19 Antibody Testing.
What should I know about other vaccines?
The American College of Rheumatology now suggests expanded use of specific vaccines in patients with rheumatic diseases who take immunosuppressive drugs .
If your age is > 18 years
- high-dose or adjuvanted influenza vaccination is recommended over giving regular-dose influenza vaccination.
- pneumococcal vaccination is strongly recommended.
- If your age is > 18 years recombinant zoster vaccine is strongly recommended.
If your age is >26 and < 45 vaccination against human papilloma virus (HPV) is recommended.