The Spine Intervention Society publishes recommendations on corticosteroid timing and effectiveness of COVID-19 vaccines

Although there is no evidence linking corticosteroid injections to decreased efficacy of currently approved COVID-19 vaccines, the Spine Intervention Society’s Patient Safety Committee recommends physicians schedule a corticosteroid injection for pain management ≥ 2 weeks before or ≥ 2 weeks after vector-based vaccine to specify the administration of a COVID-19 adenovirus. This recommendation was published in the journal Pain Medicine.

In its article, the Spine Intervention Society’s Patient Safety Committee summarized available evidence of hypothalamic-pituitary-adrenal axis suppression following epidural and intra-articular corticosteroid injections. The committee noted that studies have shown a weakening of the body’s immune response after a corticosteroid injection for pain indications, and this response appears to be greatest 1 week after the injection.

Analysis of early-stage and late-stage experimental data showed that Johnson & Johnson’s Janssen COVID-19 vaccine elicited cellular and humoral immune responses as early as 14 days after injection and protected patients from infection with the novel coronavirus. In contrast, the Oxford-AstraZeneca vaccine reported effectiveness 15 days after the second dose of vaccine.

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A Phase 3 study of Johnson & Johnson’s Janssen vaccine and the Oxford-AstraZeneca studies approved corticosteroids, but the researchers did not under-test to see if steroid exposure affected the vaccine’s effectiveness.

Given the lack of information on the relationship between corticosteroid use and the effectiveness of the COVID-19 vaccine, the Committee recommends that clinicians schedule elective corticosteroid injections ≥ 2 weeks before and ≥ 2 weeks after vaccine administration. The committee stressed that this window may not generalize to mRNA COVID-19 vaccines.

The committee wrote about the importance of a shared decision-making approach in determining the best time window for corticosteroid injections for pain associated with receiving the COVID-19 vaccination.

“These recommendations may change as more direct evidence becomes available about the effect of corticosteroid injection on the effectiveness of vaccines based on COVID-19 adenovirus vectors,” the committee wrote.

reference

Lee H., Punt JA, Patel J., Stojanovic MP, Duszynski B., McCormick ZL; Spine Intervention Society Patient Safety Committee. Will Corticosteroid Injections Used to Treat Pain Affect the Effectiveness of COVID-19 Vaccines Based on Adenovirus Vectors? Pain Med. Published online April 11, 2021. doi: 10.1093 / pm / pnab130

This article originally appeared on Clinical Pain Advisor