Throughout the past year we have seen many sources of data on how patients with rheumatologic and musculoskeletal diseases (RMDs) have been affected by the COVID-19 pandemic. I personally have been involved in many data collection and synthesis efforts regarding COVID-19’s effect on patients with RMDs, particularly a collaboration between EULAR and the Global Rheumatology Alliance (GRA). Over the past few months, as COVID-19 vaccines have become approved, and vaccination rates have increased, multitudes of data have emerged regarding COVID-19 vaccinations for patients with RMDs. EULAR even released COVID-19 vaccination guidance in December 2020 encouraging patients with RMDs to get vaccinated against COVID-19.1 Until recently, however, data regarding COVID-19 vaccines in patients with RMDs were limited. EULAR 2021 was one of the first large congresses to have presentations related to this topic, and many of the questions I and other rheumatologists had were addressed.
What do we know about the safety of COVID-19 vaccines for patients living with RMDs?
In an effort to collect information on this topic, the COVAX registry was established. The EULAR COVID-19 Vaccination (COVAX) registry, which launched in February 2021, is a voluntary registry of patients with RMDs who have received a COVID-19 vaccine. Its main goal is to collect data on the safety of COVID-19 vaccines in patients with RMDs. As part of EULAR 2021, I presented safety data collected from this registry. The data show that most patients experience short-term, nonserious adverse events that are like those of the general population, such as injection site pain, fatigue, and headache. Although they did occur, reports of RMD flares were rare (5% of patients, with 1% experiencing severe flares).2 Another small observational study of patients with RMDs receiving an mRNA vaccine also reported the vaccine to be well-tolerated.3 These initial findings are promising and support the use of COVID-19 vaccines in patients with RMDs.
Does the COVID-19 vaccine efficacy differ in patients living with RMDs who are receiving immunomodulating therapies?
Another question regarding COVID-19 vaccines for patients living with RMDs is if current therapies can dampen the vaccine response, potentially reducing the vaccine efficacy. Although data on this topic are limited, there were data presented at EULAR 2021 from 686 patients with autoimmune inflammatory rheumatic diseases (AIIRDs) who received an mRNA vaccine suggesting that, though lower than patients without AIIRDs, most patients had an adequate immune response (86% vs 100% seropositivity, respectively).4 However, it is important to note that treatment with certain medications including glucocorticoids, anti-CD20 therapy, and T-cell inhibitor therapy may impair vaccine response.4 All of these results align with the EULAR vaccination guidelines that recommend postponing anti-CD20 therapy, if feasible, when administering a COVID-19 vaccine.1 While more data in this field are sure to come, the EULAR guidelines combined with other peer-reviewed sources are a good starting resource for recommendations on how to best prepare your patients for COVID-19 vaccination.
What has been the patient response to vaccination efforts so far?
Data from EULAR 2021 suggest that willingness rates vary extensively depending on geography and patient characteristics. An international study reported approximately half of patients with AIIRDs were willing to get a COVID-19 vaccine, and rates increased with age.5 However, on a more granular level, a Belgian study reported 61% of patients were willing to get a COVID-19 vaccine, whereas rates from a Turkish study were only 29%.6,7 A study completed in Italy reported that patients with RMDs were more hesitant to get a COVID-19 vaccine than the general population.8 This wide variety of results demonstrates that each cultural context is different, but no matter where you are practicing, efforts should be undertaken to further explain the risks and benefits, and encourage patients with RMDs to get vaccinated against COVID-19, especially given the promising efficacy and safety data we saw coming from EULAR 2021.
Our understanding of the effects of COVID-19 in rheumatology will continue to evolve as more data become available; however, our current data show that COVID-19 vaccines are well-tolerated for patients with RMDs. I encourage all healthcare practitioners to continue engaging with their patients and helping them understand the value of getting vaccinated.
1. EULAR View-points on SARS-CoV-2 vaccination in patients with RMDs. December 2020. https://www.eular.org/eular_sars_cov_2_vaccination_rmd_patients.cfm.
2. Machado PM, et al. EULAR 2021. LB0002.
3. Cuomo G, et al. EULAR 2021. Poster 1248.
4. Furer V, et al. EULAR 2021. LB0003.
5. Felten R, et al. EULAR 2021. Poster 1190.
6. Sokolova T, et al. EULAR 2021. Poster 1196.
7. Yurttas B, et al. EULAR 2021. Poster 1187.
8. Priori R, et al. EULAR 2021. Poster 1219.
AIIRDS, autoimmune inflammatory rheumatic diseases; EULAR, European League Against Rheumatism; GRA, Global Rheumatology Alliance; mRNA, messenger RNA; RMDs, rheumatologic diseases.
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