Updated Recommendations for Vaccinations in Patients with RMD

The American College of Rheumatology (ACR) recently updated its guidelines to include information about vaccination treatment for patients with rheumatic and musculoskeletal diseases (RMDs), providing specific recommendations about the effectiveness and safety of vaccines that may differ among rheumatology patients as compared to the general population.

“Patients worry about the safety of vaccines and the potential for inducing a disease flare. Providers are concerned whether rheumatic diseases and the medications used to treat them could blunt the effectiveness of vaccines,” said Anne R. Bass, MD, professor of clinical medicine at the Hospital for Special Surgery and Weill Cornell Medicine in New York. “They also want to know whether certain vaccines should be given to protect rheumatology patients who are outside the age range for which they are typically recommended. This guideline was designed to address these issues.”

Focusing on the subgroup of rheumatology patients, the new summary outlines recommendations for vaccines among patients on immunosuppressants, medication management at the time of vaccination, and safe approaches to the use of live attenuated vaccines in patients on immunosuppressive medications.

A few takeaways from the updated guideline include:

• All patients with RMD, whether they are taking high-dose glucocorticoids or rituximab, should receive a seasonal influenza vaccination.
• Patients with RMD taking immunosuppressive medications should receive a pneumococcal vaccination.
• Depending on disease activity and disease progression, clinicians may hold back on methotrexate for 2 weeks after influenza vaccination.
• Wait at least 6 months after the last rituximab dose before administering vaccines other than that for influenza among patients being treated with rituximab.
• The guideline pushes for administering the adjuvanted influenza vaccination to promote a better immune response among patients under 65.
• The revised guideline also sheds light on administering the rotavirus vaccine to infants less than 6 months old vs the current standard of postponing vaccination until 1 year old among infants exposed to tumor necrosis factor inhibitors in utero.
• Clinicians are encouraged to shorten the interval between the last dose of a biologic disease-modifying antirheumatic drug and administration of a live attenuated vaccine for better efficacy.

“This new guideline recognizes that some patients, particularly very young children with autoinflammatory conditions, simply cannot stay off their medications for very long without having a severe flare of their disease. However, those patients still need to get vaccinated,” Dr Bass concluded.

—Priyam Vora

Reference:
2022 American College of Rheumatology (ACR) Guideline for Vaccinations in Patients with Rheumatic and Musculoskeletal Diseases. News Release. American College of Rheumatology; August 3, 2022. [https://www.rheumatology.org/Portals/0/Files/Vaccinations-Guidance-Summary.pdf]