J Korean Med Sci.  2021 Mar;36(12):e95. 10.3346/jkms.2021.36.e95.

COVID-19 Vaccination in Patients with Autoimmune Inflammatory Rheumatic Diseases: Clinical Guidance of the Korean College of Rheumatology

Affiliations
  • 1Division of Rheumatology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
  • 2Division of Rheumatology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
  • 3Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
  • 4Division of Rheumatology, Department of Internal Medicine, Rheumatism Center, Inha University Hospital, Incheon, Korea
  • 5Division of Rheumatology, Department of Internal Medicine, Wonkwang University, Iksan, Korea
  • 6Division of Rheumatology, Department of Internal Medicine, Kyung Hee University Hospital, Seoul, Korea
  • 7Department of Internal Medicine, Seoul Medical Center, Seoul, Korea
  • 8Department of Rheumatology, Chonnam National University Medical School & Hospital, Gwangju, Korea
  • 9Division of Rheumatology, Department of Internal Medicine, Gachon University College of Medicine, Gil Medical Center, Incheon, Korea

Abstract

The coronavirus disease 2019 (COVID-19) pandemic has caused more than 100 million infections and 2 million deaths worldwide. In up to 20% of cases, COVID-19 infection can take a severe, life-threatening course. Therefore, preventive measures such as mask-wearing, hand hygiene, and social distancing are important. COVID-19 vaccines that use novel vaccine technology can prevent up to 95% of infections. However, the uncertainty regarding the efficacy and safety of vaccination in patients with autoimmune inflammatory rheumatic disease (AIIRD), who are immunocompromised due to underlying immune dysfunction and concomitant immunosuppressive treatment, warrants clear guidance. A task force of the Korean College of Rheumatology formulated a set of vaccination guidance based on the currently available data and expert consensus. The currently available COVID-19 vaccines are considered to be safe and effective. Every patient with AIIRD should receive one of the available COVID-19 vaccines unless contraindicated for medical reasons such as prior allergy/anaphylaxis to the COVID-19 vaccine or its components. Patients should continue immunosuppressive treatment for their underlying AIIRD, including biological and targeted synthetic disease-modifying anti-rheumatic drugs (b/tsDMARDs). Corticosteroids should be reduced to the lowest dose possible without aggravating the AIIRD. To improve the vaccine response, methotrexate can be withheld for 1–2 weeks after each vaccination, and the timing of rituximab and abatacept infusion should be adjusted if clinically acceptable. Rheumatologists should play a leading role in educating and vaccinating patients with AIIRD.

Keyword

COVID-19; Autoimmune Inflammatory Rheumatic Diseases; Vaccines; Immunosuppression
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