“One concern is whether a vaccine can trigger a flare of autoimmune disease or cause autoimmune disease in someone who’s susceptible,” says Sarfaraz Hasni, MD, director of the Lupus Clinical Research Program at the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health in Bethesda, Maryland.
Autoimmune flares are an increase in autoimmune conditions.
“Studies looking at large datasets have not conclusively been able to say that getting a vaccine can trigger an autoimmune disease or cause a flare, though anecdotal reports are there,” Hasni says.
What he means is that people have reported that the vaccine has caused a sudden onset of a flare of symptoms.
The other area of concern: Can immunosuppressive drugs that help autoimmune patients manage their symptoms affect the body’s ability to mount a robust immune response to a Covid-19 vaccine?
Perhaps, Poland says. “Under normal circumstances, the [Moderna and Pfizer] vaccines are 95% effective, so roughly 5% won’t respond,” he says. “That number is likely to be higher in people on immunosuppressants.”
What he means is that having autoimmune conditions is not normal and they don't know but it is likely that more than 5% won't respond.
Poland is Gregory Poland, MD, a vaccinologist at Mayo Clinic in Rochester, Minnesota, and the director of Mayo Clinic’s Vaccine Research Group.
“In some subset of autoimmune disorders, you don’t get enough immune response to vaccines, but it’s not true across the board,” Hasni adds. Important factors include the type of disease, whether it’s active or in remission, and, most critically, the kind of medications being taken.
According to Hasni, three medications in particular can dampen an effective vaccine response:
- Rituximab is a cytotoxic medication that kills B cells, which are responsible for forming antibodies. It’s generally given via infusion once every six months. “If we can delay giving that drug for two to four weeks and give the vaccine in that window, a person should be able to develop enough immunity,” Hasni says.
- Methotrexate is used to treat multiple conditions and is administered weekly. If it can be held for two weeks before the vaccine is given and another two weeks afterward so the body can mount an immune response, that can be helpful, Hasni says. “But sometimes that’s not possible if a patient is flaring. In that case, you can still give the vaccine—it just may not be as effective as you’d hope.”
- Prednisone or other steroids are commonly used across a range of autoimmune conditions and can blunt the immune response in high doses. “If someone is on 7.5 milligrams or more daily prednisone, their response might not be as good,” Hasni says. “If less than that, it’s usually not a problem.”
As clinicians and researchers gather more data over time, there may be further recommendations regarding different vaccine dosing regimens or booster shots.
SOURCE: Elemental article by Mo Perry
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