Infectious Disease

Almost a third of the rheumatology drug regimen changed at the time of the COVID-19 vaccination

December 16, 2021

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Disclosure:
Barbhaiya does not report any relevant financial information. Co-author Lisa A. Mandl, MD, MPH, of the Hospital for Special Surgery in New York, reports on the Regeneron Pharmaceuticals grant.

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According to data published in The Lancet Rheumatology, up to 27.9% of immunomodulatory or immunosuppressive therapies were changed at the time of COVID-19 vaccination, with patients being responsible for most of the changes.

“Due to concerns about underlying immune dysregulation and immunosuppression, patients with systemic rheumatic diseases could change their medication at the time of COVID-19 vaccination to optimize their immune response and alleviate the side effects of the vaccine.” Medha Barbhaiya, MD, MPH, of the Hospital for Special Surgery in New York and colleagues wrote.

Barbhaiya_Medha_2021

According to Barbhaiya M, et al. Lancet Rheumatol. 2021; doi: 10.1016 / S2665-9913 (21) 00372-6.

“In New York state, immunocompromised patients were approved for vaccination on February 15, 2021, shortly after the American College of Rheumatology’s COVID-19 Vaccine Clinical Guidance Task Force issued its first management guidelines on February 8, 2021,” they added. “It is not known whether behavior in the real world conformed to these guidelines.”

To investigate treatment changes at the time of COVID-19 vaccination in patients with rheumatic diseases, Barbhaiya and colleagues emailed secure web-based surveys to 7,505 people between April 1 and April 21, 2020.

Barbhaiya_Medha_2021

Medha Barbhaiya

The survey collected data on immunomodulatory and immunosuppressive drugs in COVID-19 vaccination, including information on whether doses were earlier than planned, delayed, or skipped altogether. Respondents were also asked who initiated the change – either a rheumatologist, another clinician, or themselves.

Of the 2,753 people who took part in the survey by March, a total of 1,852 stated that they had received at least one vaccine dose and answered the questions about the drug adjustment completely and were therefore included in the current analysis.

According to the researchers, at the time of the first vaccination dose, there were 1,373 individual reports of immunomodulator or corticosteroid use. Before the first dose of vaccination, 15.7% of the medication schedules were changed. Of these, 41 – or 19.1% – of the drugs were taken earlier than planned, while 174 – or 80.9% – were delayed or skipped.

Modified drugs included biologics, conventional synthetic disease-modifying anti-inflammatory drugs, hydroxychloroquine, corticosteroids, and small molecules. Among these categories, TNF inhibitors – at 22.8% – and methotrexate – at 26.5% – were most frequently altered and were more likely to be delayed or skipped when the COVID-19 vaccine was taken too early. Patients and doctors were roughly equally responsible for changes in the first dose of vaccine.

At the second dose, 27.9% of 899 treatment regimens were changed. Of these medication changes, 41.8% were delayed or skipped between the first and second vaccine dose, 16.3% were taken earlier than planned, and 41.8% were delayed or skipped after the second vaccine dose. TNF inhibitors accounted for 16.3% of the changes, while MTX accounted for 33.5% of the changes around the second dose of vaccine.

Patients accounted for 49.4% of the changes at the second dose compared with 46.2% from a rheumatologist and 4.4% from another doctor. Of the immunosuppressive or immunomodulatory drugs taken early before the second vaccination dose, 73.2% were initiated by the patients. Meanwhile, rheumatologists were responsible for 52.4% of treatments delayed or skipped after the second dose of vaccine.

“We were surprised to find that many of the medication modifications around the COVID-19 vaccine were patient-centric rather than under the guidance of their rheumatologist,” Barbhaiya told Healio Rheumatology. “Some medication changes, such as B. Changes related to changing the methotrexate dosing schedule prior to a vaccine dose, or changes related to TNF inhibitors or hydroxychloroquine, were not in accordance with best practices recommended by the American College of Rheumatology Task Force. ”

She added, “While the role of drug adjustments at the time of COVID-19 vaccination and subsequent rheumatic disease flare-ups, rheumatologists can play a critical role in disseminating updated evidence-based guidance in real time regarding patient time during the ongoing pandemic future COVID-19 vaccine doses. “

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COVID-19 and rheumatology

COVID-19 and rheumatology

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