Jan 22, 2021 Arthritis COVID-19 Medication Patient Advice Dr Peter Landsberg

There has been a lot of media coverage recently about the COVID-19 vaccines that will be released in Australia soon. So I thought it might be helpful to share some thoughts here about the implications of these vaccines for our patients with autoimmune disease, arthritis, etc.  

All patients who are on medications for arthritis know that they need to talk to their doctor about various types of vaccines. In the past, these types have been broken down into vaccines that are made with a living virus (which should be avoided by anybody on immunosuppressive medication) versus those vaccines which are made out of dead viral material. 

The three living vaccines that have been most widely used in Australia are those for measles, mumps and rubella as a single vaccine, yellow fever vaccines and the shingles vaccine. All these vaccines are contraindicated for anyone who is on immunosuppressive medications, including prednisone, methotrexate, biological drugs (like Simponi, Humira and others) and more.

All the other common vaccines, including those given for tetanus, the flu, meningitis, pneumonia and polio, are not living vaccines and so are safe to be given to any patient, unless they are allergic to some component of the vaccine.  

There are over 50 vaccines that have been developed around the world to treat COVID-19. None of these vaccines have been trialled so far in patients who are immunosuppressed or on immunosuppression therapy. Development of these vaccines has been fast tracked a little because of the urgency of the worldwide pandemic. 

We’ll have access to more information about what happens to patients who are immunosuppressed or have any autoimmune disease as time goes by, but initial evidence is showing that there are no problems at all. As at today’s date, there have been well over 50 million vaccines administered around the world and apart from a few allergies, there have really been no major issues. It is looking very hopeful.  

There was some concern last week, as a small group of frail, elderly individuals in Norway died shortly after receiving a COVID-19 vaccination. However, the World Health Organization’s Committee on Vaccine Safety followed up later in the week,  saying that it could see no evidence that the COVID-19 vaccine contributed to the deaths of that group of elderly people and urged that the shot still be used. Stating that the risk-benefit balance of the vaccine “remains favorable in the elderly.”

As you know, there are three vaccines that will probably be coming our way here in Australia. The ones that have been most talked about are the vaccines from Pfizer, Moderna and AstraZeneca.

The Pfizer and Moderna vaccines have been made using very new technology which makes use of a small protein called messenger RNA (mRNA). The messenger RNA carries instructions from the coronavirus genetic code. This shows our cells how to manufacture the coronavirus spike protein, those little protrusions always featured on the diagrams you see on every news bulletin. This teaches your body to recognise the spike protein on a living coronavirus as foreign, and to mount an immune system response. 

The mRNA is very delicate, and therefore the vaccine is encased in a lipid particle envelope to transport the messenger inside human cells. The Pfizer and Moderna envelopes are made differently and this is why they need to be stored differently. 

Both vaccines will probably require at least two doses, probably 3-4 weeks apart. The AstraZeneca vaccine and also a Johnson & Johnson vaccine have been made using a different process using a viral vector. This uses a virus that causes the common cold known as adenovirus to get the mRNA where it teaches the body to recognise the coronavirus spike. The adenovirus has been genetically modified, so it cannot replicate or cause disease. These vaccines will probably also require two doses.  

So, technically none of these viruses are living vaccines. The vaccines do not contain any living coronavirus, and cannot breed or cause coronavirus. Questions that we don’t yet have answers to, are whether medications that patients are taking for autoimmune disease might suppress how effective the vaccine is, or whether having the vaccine might stir up the autoimmune disease. 

Certainly, we have seen patients who have had the flu vaccine have flares of their rheumatoid arthritis, and I guess it is a risk versus benefit analysis. We’d hope that the patients that are on stable medications will only have minor flares, if any flares at all, but only time will tell. 

However, with the great danger of the coronavirus, I think that is a small risk compared to the benefit of having the vaccine. It is certainly possible that powerful immunosuppressive drugs like cyclophosphamide and rituximab might reduce the strength of someone’s antibody response following COVID-19 vaccination, but it is certainly not a reason to avoid having the vaccine. Any benefit is a benefit.  

So, in summary, there is not a lot of data available as yet about what happens when patients who are immunosuppressed or have an autoimmune disease have these COVID-19 vaccines. But they are not living vaccines, so do not carry the risks associated with this type of vaccine. So far, in the millions of people who have had vaccines, there have been no red flags, apart from very rare allergies. I’ll certainly be volunteering for a vaccine when it is available and recommended for all Australians. I’ll be recommending it to my patients too. 

For more information I would recommend visiting the Creaky Joints website. This is a terrific site that has a wonderful summary of all this information.

COVID-19 Vaccine Information for Immunocompromised Patients

Getting a COVID-19 Vaccine: What to Know If You’re Immunocompromised

 

 

Dr Peter Landsberg

About The Author - Dr Peter Landsberg

Dr Peter Landsberg practices general Rheumatology with a special interest in inflammatory arthritis and connective tissue disorders. His holistic approach to medicine stems from the 12 years he spent as a GP before studying Rheumatology. On weekends you’ll find him trying (not always successfully) to stay upright on his mountain bike as he rides downhill tracks. Or out on Moreton Bay in his well-used tinnie, fishing with his family and the dog!


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