COVID-19 Vaccines and Spondyloarthritis: What You Should Know
An ambitious vaccination program is now underway in the U.S., ever since the U.S. Food and Drug Administration (FDA) issued emergency use authorization for Pfizer and BioNTech’s COVID-19 vaccine on December 11th and Moderna’s vaccine one week later. Many in the spondyloarthritis (SpA) community have written to us with questions about how the vaccines may interact with SpA, biologics, HLA-B27, and other factors related to living with this family of diseases.
SAA hosted a Facebook Live discussion on COVID-19 vaccines and SpA on December 9th to address these questions and many more, with two medical experts: Dr. James Rosenbaum, rheumatologist, and Dr. Kevin Winthrop, infectious disease epidemiologist. Here, we summarize some key points from our live conversation. Be sure to watch the whole program here for much more in-depth information.
Were people living with ankylosing spondylitis or related diseases included in clinical trials so far?
Likely not. Phase 3 clinical trials such as this one do not seek to include people who have immune-mediated inflammatory arthritis conditions or who may be immunocompromised. “The protocols are written that you may have a chronic underlying condition, but if it’s well-controlled and stable” those individuals might have gotten in, Dr. Winthrop said. But in general, “folks with a lot of those diseases would have been excluded from the trials.” Medications such as biologics were exclusionary for the trials as well, he added.
“It would be very unusual for a company to include immunocompromised individuals in their initial trials,” Dr. Rosenbaum agreed. Other groups, such as pregnant or breastfeeding women, are also typically excluded from these trials.
Are the COVID-19 vaccines safe for people with spondyloarthritis?
Yes, the doctors believe the vaccines are safe for people with SpA. “There’s nothing about the biology of what’s being injected to make us think that anyone with spondyloarthritis is at special risk,” Dr. Rosenbaum said. “You’re absolutely not going to get COVID-19 from the vaccine. There’s no reason to believe that people with spondyloarthritis or people on immunosuppressants are going to have more side-effects from the vaccine.”
In fact, Dr. Winthrop said people in this category may have fewer side-effects (read below for more).
Can those taking biologic medications get a COVID-19 vaccine?
Our medical experts have said that yes, patients on biologics can get vaccinated for COVID-19. What we need to understand is that biologics may dampen the body’s response to the vaccine – meaning the vaccine may provide lower levels of protection against COVID-19 for those on biologics.
Dr. Winthrop notes that because of this, a person on biologics may experience fewer of the common side-effects of the vaccines, such as fatigue, headache, or injection site achiness. “I would suspect that this group of people are probably going to tolerate the vaccine better and have less of that reactogenicity,” he said.
“Then the question is, are they going to mount as protective an immune response to the virus or not? Most of us would say they probably won’t. The people who have immune systems that aren’t quite as strong or robust, they just don’t have the same response [to vaccines]. We see this same type of phenomenon with most immunosuppressants. It depends on the dose and the type of drug. Most of the drugs that are used with this condition will probably dumb down the immune response to the vaccine.”
Dr. Winthrop said that as further studies are done in the future, we may find out that people taking biologics may need a higher dose of vaccine, or an extra booster dose of the vaccine. “These are things we figure out with time and additional studies,” he said.
Dr. Rosenbaum added, “If anything, someone with spondyloarthritis on biologics is going to have less risk [of vaccine reactions]. The question is, will that same individual have less benefit. You may have fewer symptoms after you get the vaccine, but that probably correlates with making a less robust immune response.”
Should patients pause a biologic before or after getting vaccinated?
The ACR has formed a taskforce to study this question (of which Dr. Winthrop is a part). In a previous study, patients who stopped methotrexate for two weeks from the date they got the flu vaccine had a slightly better immune response. “Whether that translates to other vaccines, we don’t know,” Dr. Winthrop said. “There may be some rationale in skipping a dose of a TNF-blocker [or IL-17 inhibitor] prior to receiving the vaccine. That’s an open question.” They are going to study this question with regard to the new mRNA vaccine.
Dr. Rosenbaum says whether or not a patient should pause a biologic to get the vaccine will be an individual question. It largely depends on whether a person is comfortable stretching the time between doses, or would suffer too much from delaying a dose. His advice is this: Pause your biologic if you can – both before and after receiving the vaccine – but if you can’t, you can still get the vaccine anyway. The vaccine’s efficacy may be reduced, but you stand to benefit more from getting immunized. “Try to maximize the time from your TNF inhibitor until you get the immunization. And then try also to delay a little bit getting the TNF inhibitor after the immunization, because that’s a critical time for your immune response,” he said. “Even if you have a somewhat diminished response, I think you’re going to have a decent level of protection now, and probably an opportunity to boost it later.”
Are the Pfizer or Moderna vaccines “live” vaccines?
No, neither vaccine is a live vaccine. Live vaccines use a weakened form of the virus that causes a particular disease, and can potentially pose problems for those on immunosuppressant medications. Both of these vaccines use a new vaccine technology and are called mRNA vaccines. These vaccines have been shown to be 90-95% effective against the virus that causes COVID-19, and neither of our medical experts believe these vaccines pose any greater risk to those with SpA or those taking biologics.
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