Some insights but still many problems to solve in optimising vaccine administration and addressing patient concerns.
The American College of Rheumatology ran a town hall on the covid vaccines’ effectiveness in immunosuppressed and rheumatic disease patients.
While many studies are starting to provide insights about which medicines might be of concern, there are still many problems to solve in both optimising vaccine administration in rheumatic disease patients and bringing those patients along on the journey.
Rheumatologist Dr Alfred Kim, Assistant Professor at Washington University School of Medicine, kicked off proceedings with a review of what we know so far about the effects of immunosuppressants on vaccine response in this patient group.
@alhkim summarizes impact of immunosuppressants on #COVIDvaccine response@ACRheum Townhall #CovidVaccine pic.twitter.com/AykIlAaLXq
— k dao (@KDAO2011) August 4, 2021
He also highlighted some of the many unknowns. For example, we can measure the level of antibodies but we don’t know what level is needed to mediate protection.
Then there are the different covid variants, in particular Delta, where people who are vaccinated can still transmit the virus: are these breakthrough infections more likely in the immunosuppressed? What sort of protection do vaccinated patients have against severe covid?
Drug holidays are still an unknown, despite recommendations from ACR and others.
“I think what’s not clear is the timing,” said Dr Kim. “How long do you have to hold before and after vaccination in order to generate these optimal responses?”
Unknowns:
— k dao (@KDAO2011) August 4, 2021
👉What level of Ab are protective?
👉Are breakthrough infx more likely with immunosuppressed?
👉Durability of vaccines?
👉Roles of T cells
👉timing of vaccine and dosing of meds?@alhkim @ACRheum Townhall #COVIDVaccine pic.twitter.com/sfmsyRib5y
Dr Jean Liew, Assistant Professor of Medicine at Boston University School of Medicine, presented unpublished data from the COVID-19 Global Rheumatology Alliance (GRA) Vax Survey.
The GRA has surveyed – and is continuing to survey – people with rheumatic disease to understand their perceptions of and experience with the covid vaccine. The data was based on around 3000 responses.
Around two-thirds of patients agreed they’d discontinue medications if it was helpful for vaccine effectiveness. However, patients on steroids were less willing to give discontinue medication, likely because they had more serious disease and had been told not to suddenly stop taking their medication due to potential negative effects.
Almost a half of patients reported having at least one side effect that lasted more than two days, and all of these were common side effects of the vaccines. This compared with about one third of patients having side effects as reported by physicians in the EULAR Covax registry.
By and large, disease activity remained stable after vaccination. In the EULAR Covax physician-reported registry, around 5% had a flare and 1.2% were reported as severe flares. In the GRA survey, 13% reported a flare that lasted at least two days and about 5% reported a flare that required a medication dosage change.
From my talk:
— Rheum Cat (@rheum_cat) August 4, 2021
1) vaccine SEs in RMD pts
2) RMD flares after vaccination
Not as comprehensive as @alhkim‘s pic.twitter.com/s3sRtwcR5f
Vaccine hesitancy continues to be a concern and Dr Liew emphasised the importance of two-way communication.
“We know that there are many patients that are still hesitant or deliberating about vaccinations. So, we need to have continued communication about that and then, when they’re ready, to have shared decision making with them about whether it’s appropriate for them to hold their medications around with the covid vaccine in order to boost efficacy,” said Dr Liew, adding that it’s not necessary for all cases and comes down to the individual – uncertainties alluded to by Dr Kim notwithstanding.
The GRA Covid-19 Vax Survey is still open.
A recording of the Town Hall is available on YouTube.
