covid vaccine for lupus patients

12/18/2020

Should lupus patients get the COVID-19 vaccine?

News Flash COVID-19 vaccine for lupus patients

What I tell my systemic lupus patients as of 12/18/20: 4:00 PM

The Advisory Committee on Immunization Practices (ACIP) of the CDC made the following recommendations on 12/18/20 regarding vaccination in patients with autoimmune disorders. I'll first put in verbatim what was said (courtesy of the RheumNow website), then give my recommendations in a nutshell.

The ACIP of the CDC states:
< > = is wording that I inserted

"Persons with underlying medical conditions <such as lupus and other autoimmune disorders>:

... the vaccine may be administered to persons with underlying medical conditions who have no contraindications to vaccination. Phase 2/3 clinical trials demonstrated similar safety and efficacy profiles in persons with some underlying medical conditions, including those that place them at increased risk for severe COVID-19, compared to persons without comorbidities.

Immunocompromised persons: Persons with HIV infection, other immunocompromising conditions, or who take immunosuppressive medications or therapies might be at increased risk for severe COVID-19. Data are not currently available to establish vaccine safety and efficacy in these groups. Persons with stable HIV infection were included in phase 2/3 clinical trials, though data specific to this group are not yet available. Immunocompromised individuals may still receive COVID-19 vaccination if they have no contraindications to vaccination. However, they should be counseled about the unknown vaccine safety profile and effectiveness in immunocompromised populations, as well as the potential for reduced immune responses and the need to continue to follow all current guidance to protect themselves against COVID-19."

What I will tell my patients:

If you have lupus and just take an antimalarial such as Plaquenil:
- In the clinical trials, patients with underlying medical conditions with no contraindications to vaccines did as well with the COVID-19 vaccine as healthy people.
- This would apply to lupus patients who take hydroxychloroquine (Plaquenil). Plaquenil does not suppress the immune system.

If you take an immunosuppressant:
- Patients who take immunosuppressants (such as prednisone > 7.5 mg a day, mycophenolate, CellCept, azathioprine, Imuran, methotrexate, leflunomide, cyclophosphamide, cyclosporine, tacrolimus, Benlysta, and Rituxan) may get vaccinated if you do not have a contraindication to getting vaccines. However, the safety and effectiveness is unknown. There is always the chance that the vaccine may not work as well (in other words, not 95% effective). Therefore, you can never let your guard down. You must continue to practice strict infection prevention measures (washing hands, disinfecting, mask wearing, social distancing).

The Lupus Foundation of America put out additional information below:

https://www.lupus.org/resources/covid19-vaccine-and-lupus

The photo above of Covid vaccine comes from the LFA website

Opinion about the COVID-19 vaccine for lupus patients

How about you? Are you going to get the vaccine?

Share your opinions and comments by clicking "COMMENT" above

Author

Don Thomas, MD, author of "The Lupus Encyclopedia" and "The Lupus Secrets"

11 Comments

Categories

The Lupus Encyclopedia: A Comprehensive Guide for Patients and Families (A Johns Hopkins Press Health Book) Illustrated Edition
by Donald E. Thomas Jr. MD FACP FACR (Author)

The Lupus Encyclopedia is an authoritative compendium that provides detailed explanations of every body system potentially affected by the disease, along with practical advice about coping. People with lupus, their loved ones, caregivers, and medical professionals―all will find here an invaluable resource. Illustrated with photographs, diagrams, and tables, The Lupus Encyclopedia explains symptoms, diagnostic methods, medications and their potential side effects, and when to seek medical attention. Dr. Donald Thomas provides information for women who wish to become pregnant and advises readers about working with a disability, complementary and alternative medicine, infections, cancer, and a host of other topics.

FOLLOW US ON SOCIAL MEDIA

Lawna Bourassa

12/18/2020 02:40:20 pm

If it is not a live vaccine why does it need to be kept frozen?

Don Thomas, MD

12/18/2020 07:27:04 pm

Dear Lawna: The vaccines for COVID-19 contain a very fragile portion of the virus called messenger RNA. Messenger RNA is very fragile and destroys easily with higher temperatures. I am not sure how they came up with such a low temperature, but this is only for storage. Great question! Brrrrrrrr

Ann Utterback

12/18/2020 04:55:26 pm

Thank you so much for this, Dr. Thomas! As always you’re right on top of things, & you share your knowledge with us.
It really takes away the worries I’ve had. I’m on 3 mg/day of Prednisone so it sounds like I am no different than healthy individuals in my age group. Good news!

12/18/2020 07:28:34 pm

Thanks for your kind words as always, Ann. I was also waiting eagerly for the guidance. Good luck and I hope you can get yours soon. Make sure to share your experience with us after you do. This information will help others

Cindy Moine

12/18/2020 05:02:19 pm

I just had my rituxan infusion on the 16th and another on the 30th. I think I'll be waiting a bit for this vaccine. In the meantime I'll keep being careful as always.

12/18/2020 07:30:51 pm

Cindy: Great point. You are most likely well aware that you need those B cells to respond to vaccinations. Experts recommend getting vaccines about 2-4 weeks before each round of Rituxan (when Bcell activity should be increasing again). That is what I'll recommend to my patients. My biggest quandary is someone like you who also works as a hospital radiology tech. She just got her Rituxan. What a tough situation! ... Dr T

Elle Kay

12/18/2020 05:19:54 pm

My daily meds Cellcept, Prednisone, Coumadin, Dilantin, Plaquenil, and Benlysta infusions. I'm waiting.

Ellen Neudecker

12/18/2020 09:50:07 pm

It would be great if a large number of Lupus patients would participate in a project to test the efficacy rates of the different Lupus patients. We all have different medicine regimes and comorbidities, but even just to break the Lupus patients into “taking immunosuppressant s” vs. “not taking immunosuppressants”. Obtain information at the beginning about medications the patient is taking and which type of vaccine they received. Do a tiger to test immunity a few weeks after the second dose. Do another tiger at six months post vaccine. Do a final tiger at one year post vaccine, when they are predicting that immunity will end in healthy people. This would be wonderful information to analyze and report so that those of us on multiply suppressants, and who are at higher risk for more severe COVID. Just a thought...

12/30/2020 12:29:42 pm

I got mine on 12/29/20. I got the Moderna brand. Read my post to learn how to vaccine works and how I did after the shot:

https://www.lupusencyclopedia.com/blog/how-the-covid-19-vaccine-works-amazing

Christa

12/31/2020 11:53:36 pm

Hello! I have SLE and only take Plaquenil. I had the Modern COVID-19 vaccine. Should I still expect to receive the 94% protection from COVID, even though I have Lupus?

1/2/2021 04:51:54 pm

Christa: You should. Hydroxychloroquine does not suppress that part of the immune system necessary for vaccination responses. Studies on other vaccines show no problems in people who take HCQ. Good job that you got it!

Lupus Encyclopedia