The Pfizer COVID-19 RNA virus vaccine booster shot was studied in immunosuppressed patients: could a COVID booster vaccine for lupus patients be beneficial?

Immunosuppressed Patients Respond to Booster Shots: Hope for a COVID Booster Vaccine for Lupus and Other Autoimmune Disease Patients? [Updated 8/12/21]

 

Will a COVID Booster Vaccine for Lupus Patients Increase Response Rates?

We do not know, yet. However, the August 12, 2021 edition of the New England Journal of Medicine reported significant responses in immunosuppressed organ transplant patients. This provides hope that a COVID booster vaccine for lupus patients, and other autoimmune disease patients, who are immunosuppressed may also respond well.

The Problem: Early reports from COVID vaccine studies suggest that patients on immunosuppressants have lower response rates. The Johns Hopkins Hospital study has already suggested that patients on mycophenolate mofetil, rituximab, and steroids (when combined with another immunosuppressants) have high rates of nonresponse.

This leaves immunosuppressed patients, such as lupus patients, unsure of how well they responded to their COVID vaccines and they must remain vigilant with social distancing, mask wearing, etc. Unfortunately, the usual COVID antibody tests available to most doctors do not test for antibodies to the SARS-Cov-2 spike protein, which is essential to test for vaccine responses, so few patients know if they responded or not.

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Moderna and Pfizer Vaccines: How Effective is One COVID shot?

CDC Study answers this question

COVID-19 vaccine for lupus patients: One COVID shot effective?
Is just one COVID shot effective?

Please get your COVID-19 vaccine! We all would like life to go back to normal. The unvaccinated will be our major obstacle in reaching that goal. (and yes, that is my, and many others, unapologetic opinion)
QUESTION: How effective is just one COVID Shot if you did not get the second?
ANSWER: 82%

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“Do I need a mask after vaccination?” Now here is the truth

Male lupus patient with a mask

Please continue to protect yourself as you did before if you have lupus or another systemic autoimmune disease and are vaccinated against COVID-19

QUESTION OF THE DAY:

Dr. T. I have lupus. I got both of my Moderna COVID vaccines. Can I take off my mask like the CDC recommends?

ANSWER:

I am so glad you asked this question!

NO! (generally, see exceptions below)

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COVID Vaccine and Lupus: Join in a Research Study Now to See if it Worked

How the COVID Vaccine and Lupus Interact is Important to Figure Out: Consider Joining this NIH Research Study

The NIH is studying how the COVID vaccine and lupus interact. Please consider participating in this important research.

You can also click on this link to read more about the study and what in entails.

We also need healthy volunteers and patients who have other autoimmune diseases as well. Share this information with your friends, family, and loved ones. You must live close enough to the NIH in Bethesda, Maryland in order to participate as you need to travel there for the study.

Note that they will reimburse you for your participation. You will also find out what your SARS spike protein antibody result is (how well you responded to the vaccine).

Join the NIH study to learn about the COVID vaccine and lupus
Join the NIH study to learn about the COVID vaccine and lupus

Author

Don Thomas, MD, author of “The Lupus Encyclopedia” and “The Lupus Secrets

Provocative Advice: Lupus Patients need COVID Vaccines [2021]

Evaluation and recommendations by noted lupus experts: Lupus patients need COVID vaccines

Newspaper on fire about lupus patients and COVID-19 vaccines

Hot off the press from Lupus Science & Medicine
revised 6/13/21: Added mycophenolate, NSAIDs, and Tylenol to the list of drugs that should be held for vaccines

SARS-CoV-2 vaccines in patients with SLE
Link and reference below to the research studiesSummary of some main points (but I encourage you to read the article):

– This article is written by some of the world’s experts in lupus
– Dr. Joan Merrill, Dr. Anca Askanase, Dr. Wei Tang, and Dr. Leila Khalili

“… the risks of not receiving the vaccine are far greater at the present time.”

 The lupus experts also state,
“Patients with autoimmune rheumatic diseases should receive the COVID-19 vaccines and should be prioritized before the general population.”
– Other vaccines have been shown to be safe in lupus patients.
– They recommend temporarily stopping or changing the dosing schedule on some drugs, such as cyclophosphamide, methotrexate, mycophenolate (CellCept, Myfortic), rituximab (Rituxan), abatacept (Orencia), JAK inhibitors (Xeljanz, Olumiant, Rinvoq), NSAIDs, and Tylenol.

They recommend following the recommendations of the American College of Rheumatology (click on link)

– They recommend that doctors may want to consider monitoring antibody levels after the vaccine.
– Since we do not know how well lupus patients, patients with other autoimmune diseases, and immunosuppressed patients will respond to the vaccines, they should continue strict social distancing.
– The above recommendations are made without research regarding specifically these RNA vaccines. However, after evaluating all the data, The American College of Rheumatology and these lupus experts recommend vaccination in patients with autoimmune rheumatic diseases. 

What are the risks of COVID-19 infection when lupus patients get infected?

– They are not at higher risk for infection from the novel SARS-CoV-2 Coronavirus.
– However, they are at higher risk of hospitalization than the general population.
– COVID-19 infection may even increase lupus flares.

Please get your vaccine.  I got mine and I recommend it to all my patients.
This is not a substitute for your doctor’s advice. Please check with your physician first. 

Author

Don Thomas, MD: author of “The Lupus Encyclopedia” and “The Lupus Secrets

References:
Tang W, Askanase AD, Khalili L, et al. SARS-CoV-2 vaccines in patients with SLE. Lupus Science & Medicine 2021;8:e000479. doi: 10.1136/lupus-2021-000479

​American College of Rheumatology (ACR) COVID-19 Vaccine Clinical Guidance Task Force. COVID-19 vaccine clinical guidance summary for patients with rheumatic and musculoskeletal diseases, 2021www.rheumatology.org/Portals/0/Files/COVID-19-Vaccine-Clinical-Guidance-Rheumatic-Diseases-Summary.pdf. Available: https:///www.rheumatology.org/Portals/0/Files/COVID-19-Vaccine-Clinical-Guidance-Rheumatic-Diseases-Summary.pdfGoogle Scholar

Allergies and Itching after COVID vaccine? Announcing Research Here

Results from 64,900 vaccines: How often are allergies and itching after COVID vaccine?

Urticaria hives allergic reaction in systemic lupus erythematosus SLE

Hives (urticaria) photo credit: James Heilman, MD, Wikipedia, “Hives”

​Journal of the American Medical Association Research Study: March 2021

(reference and link to the study are at the bottom of the page)

Easy-to-Read Results Summary:

– Researchers did this study based on the fact that many are nervous to get the vaccines due to having allergies themselves and all the media-hype regarding allergic reactions causes some people to avoid the vaccines.

So… what is the truth?
– Study was done at Massachusetts General Brigham (the Original Harvard hospital!)
​- Studied what happened the 3 days after the first vaccine (the time of highest chances for allergy symptoms)
– 40% got Pfizer, 60% Moderna

Mild allergic reactions
– 1 out of every 50 vaccines caused mild allergic reactions (itch, hives, swelling)
– Moderna (2.2% of the shots caused mild allergy) vs Pfizer (2% of the shots): not much difference
– 98% of all people had no allergic reactions at all (that is a nice, safe number)

Significant allergic reactions (anaphylaxis)
– Occurred in 1 out of every 3700 Pfizer shots (i.e. .027% of the shots)
– Occurred in 1 out of every 4300 Moderna shots (i.e. .023% of the shots)
– In total, there were 5 anaphylactic reactions per 20,000 vaccines (that is a really safe number compared to many other drugs)

Moderna and Pfizer COVID-19 mRNA vaccines for lupus patients

Pfizer and Moderna were pretty similar in how often they caused allergic reactions: very low numbers
​Timing for significant allergic reaction (anaphylaxis)
– An average of 17 minutes after the shot
– The range was from immediately after the shot up to 2 hours later at the latest
Anaphylaxis severity
– 7 of the 16 patients had mild skin reactions
– 9 of the 16 patients had “measurable” but not life-threatening reactions
– 3 did not seek any medical attention
– 1 went to the ICU and recovered
– 9 out of 16 patients needed an epinephrine shot (EpiPen) and all recovered
– There were no severe anaphylactic reactions (having shock or requiring intubation)

Who was most likely to get anaphylaxis?
– Out of 16 patients in total, 5 (31%) had a history of anaphylaxis
– 10 out of 16 (61%) had a history of allergies (probably not significantly different than the usual population)

“I have a history of anaphylaxis, what is my risk?”
– Assuming there were 4000 individuals with severe food or drug allergies in this group (this is the expected #)
– Only 5 out of 4000 people with a history of anaphylaxis get an anaphylactic reaction (1 out of every 800)
– Knowing that this is a group of people who are used to planning for anaphylaxis and should have an EpiPen, and who know they have to use it when exposed to a known allergen (like me when I accidentally eat shrimp), that is an incredibly low number.
– I took my EpiPen with me when I got mine. No problems! Only 1 out of every 800 times would someone need to use it

Bottom lines
– Since the results were reported by the employees themselves, and not confirmed by doctors, we cannot ensure that these were truly anaphylactic reactions (people do tend to overestimate such responses = my opinion)
– The researchers, Harvard-famous allergy experts, stated, “… the overall risk of anaphylaxis to an mRNA COVID-19 vaccine remains extremely low”

If you have had an anaphylactic reaction in the past (like I have), I recommend:
– Just take your EpiPen and wait a while after your shot if you have had anaphylaxis before. However, don’t sweat it.

You have a higher chance of getting into a car accident on the way to the shot than you do of getting an anaphylactic reaction

Did you get your vaccine? How did you do?
COMMENT BY CLICKING ON “Comments” ABOVE

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Author

Don Thomas, MD author of “The Lupus Encyclopedia” and “The Lupus Secrets

Lupus and Sleep: Strategies to Sleep Better!

Lupus and Sleep Problems are Common! Here are simple, effective strategies to improve your sleep

Tips on better sleep

Lupus and sleep problems are real. The lack of sleep has been associated with numerous problems such as fatigue, memory and concentration problems (lupus fog), gaining weight, and even lupus flares!
Learn to see better using the “sleep hygiene” techniques below.

How to use:
Sit down, read the list, use a yellow highlighter on anything you are not doing regularly.
Work faithfully on incorporating every single thing into your life.
If you then still have trouble sleeping, talk to your doctor. Ask if you should get a sleep study to figure out if you have a treatable sleep disorder

Get other advice for living better with lupus from “The Lupus Secrets

Thank you Kelli of “More than Lupus” for posting the Ask Dr. T question

Sleep Hygiene Techniques

​- Maintain a regular sleep schedule; get up and go to bed the same time daily even on non-work days and holidays.
– Reduce stress in your life.
– Get exposure to light first thing in the morning to set your biological clock. Consider using a non-UV source of light exposure such as the Philips goLITE or the Miroco non-UV light.
– Exercise daily; mornings and afternoons are best. Don’t exercise right before bedtime.
– Avoid naps late in the afternoon or evening.
– Finish eating two to three hours before bed; a light snack is fine, but avoid foods containing sugar as it can stimulate the mind and interfere with falling asleep.
– Limit fluids before bed to keep from getting up to urinate throughout the night.
– Avoid caffeine six hours before bed.
– Do not smoke; if you do, don’t smoke for two hours before bed; nicotine is a stimulant.
– Avoid alcohol two to five hours before bed; alcohol disrupts the sleep cycle.
– Avoid medicines that are stimulating (ask your doctor).
– Avoid stimulating mind activities for a few hours before bed (reading technical articles, listing tasks to do, trouble-shooting, paying bills, etc.).
– Have a hot bath one to two hours before bed; it raises your body temperature and you will get sleepy as your temperature decreases again afterward.
– Keep indoor lighting low for a few hours before bed.
– Establish a regular, relaxing bedtime regimen (aroma therapy, drink warm milk, read, listen to soft music, meditate, pray, do relaxation/breathing exercises).
– Ensure your sleeping environment is quiet and comfortable (comfortable mattress and pillows; white noise like a fan; pleasant, light smells).
– If pets ever wake you, keep them outside of the bedroom.
– Use the bedroom only for sleep and sex; never eat, read, or watch TV in bed.
– Never keep a TV, computer, or work materials in your bedroom.
– Go to bed only when sleepy.
– If you can’t go to sleep within fifteen to twenty minutes in bed, go to another room and read something boring under low light, meditate, pray, listen to soft music, or do relaxation/breathing exercises until sleepy.
– If you have dry mouth problems, use a mouth lubricant such as Biotene Mouth Spray before you go to bed.

What is the Best Non-Drug Treatment for Insomnia?

The experts recommend “Cognitive Behavioral Therapy for Insomnia” (abbreviated as CBT-I)
It is very easy to find many online CBT-I courses with high success rates

Author

Don Thomas, MD, author of “The Lupus Encyclopedia” and “The Lupus Secrets

Can Lupus Cause Tooth Decay? Sure!- But now preventable!

Dry mouth from lupus and Sjogren's syndrome causing low pH, dental cavities, and tooth loss

Can lupus cause tooth decay? Learn here to lower your risk of losing teeth from dry mouth!

Saliva production is very important in keeping bad bacteria away and keeping our teeth and gums healthy. There are things you can do to help.

“Can lupus cause tooth decay?”

Dr. Thomas, can lupus cause tooth decay?” Unfortunately, this is not an uncommon question from young patients of mine who have systemic lupus erythematosus and other autoimmune diseases, such as Sjogren’s disease and rheumatoid arthritis.

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Lupus and Hepatitis B Vaccine: Endorsed in the CDC guidelines

Lupus and Hepatitis B

That is right! Lupus and hepatitis B infection is not a good combination and needs to be prevented. Vaccinations are one way to do this. Many of you reading this post should get the hepatitis B vaccineLess commonly known reasons for getting a Hep B vaccine include:

– Diabetics aged 19 through 59 who have not been vaccinated! People with lupus who have taken steroids are at higher risk for diabetes, so diabetes is not uncommon in lupus patients.
– Anyone with fatty liver disease. Unfortunately, most systemic lupus patients are over weight due to many reasons. They therefore are at higher risk of fatty liver disease.
– An ALT or AST (liver blood tests) greater than twice the upper limits

Read the below link to learn why these groups should get a hepatitis B vaccine per the CDC

Here is the CDC’s rationale for these groups getting vaccinated as well as a list of other at risk individuals who should get vaccinated: https://www.cdc.gov/vaccines/vpd/hepb/hcp/index.html

Many of you reading this should get it based upon this and you (and possibly even your doctor) did not know.

The importance of lupus and hepatitis B: Get your hepatitis B vaccine. Getting all your vaccines to prevent potentially deadly infections is part of “The Lupus Secrets.”

Dr. Donald Thomas, MD

Photo shows a man with jaundice (note the yellow eyes) due to hepatitis. (photo credit = CDC)

Man with yellow eyes due to jaundice from hepatitis
Man with yellow eyes due to jaundice from hepatitis


Lupus Flare After Flu Shot? Question of the Day Here

Do Flu Shots Cause Lupus Flares? Lupus flare after flu shot?

Question of the day: Dr. Thomas, I have lupus and was told by another lupus patient that she gets a flare when she gets a flu shot. Do flu shots cause lupus flares?  – JP
ANSWER: “No and Yes; in that order”

Fortunately, the vast majority of systemic lupus erythematosus (SLE) patients do not get a flare after getting the flu shot. A recent study showed that only 32 SLE patients out of 1966 (1.6%) who got the flu shot (influenza vaccine) had flares from their SLE, and all were mild. I have never had a patient get a severe flare from the flu shot over 30 years. I had one severe flare from Pneumovax, though.

Now the really interesting thing about this study is as follows… it would be very easy to conclude “the flu shot must cause flares in 1.6% of SLE patients.” However, that is not true. Imagine studying 1966 SLE patients even for just a very short period of time. I find it amazing that only 32 out of 1966 would flare. You’d expect more of them to flare during the study period simply because that is what lupus likes to do.

Compared to healthy controls, they responded very well to the vaccine as far as it protecting them from the flu.

It is flu season. Please get your flu shot. Especially with COVID-19, we do not want a one-two punch!

NOTE: The Centers for Disease Control recommends getting the flu shot BEFORE the end of October.

(Many people misinterpret this as they should get it in October). Their only warning about this is that elderly vaccine recipients may have the vaccine response be a little weaker at the end of the flu season if they get it in July or August. Otherwise, it is best to get it as soon as it is available to help decrease community spread.

Please SHARE my post with others.

Click the COMMENTS button above regarding your experience with the flu shot when you have lupus. Would love to hear from people who have had no problems at all and those who have.

– by Don Thomas, MD, FACP, FACR