The ACR Updates COVID-19 Vaccine Guidance for Patients With Rheumatic and Musculoskeletal Diseases

The American College of Rheumatology (ACR) recently updated their guidance on the use of COVID-19 vaccines among patients with rheumatic and musculoskeletal diseases (RMDs). The updated recommendations are currently available on the ACR website.

The ACR noted that, “these recommendations were added to the full paper…, which will be submitted to [the journal] Arthritis & Rheumatology for publication.”

In the fifth and latest guidance, the ACR updated guidance related to the dosing, use, and timing of COVID-19 vaccines, immunomodulatory therapy, and monoclonal antibody treatment for patients with RMDs. The guidance was developed based on recommendations by the US Centers for Disease Control and Prevention (CDC) for immunocompromised individuals.

·   Patients with autoimmune inflammatory rheumatic diseases (AIIRDs) who have received the primary COVID-19 vaccine series with suspicion of an inadequate vaccine response should be advised to receive a supplemental dose.

·   Patients with RMDs who have received the primary and supplemental COVID-19 vaccine doses are recommended to receive another booster dose. The ACR noted that the timing of intervals for vaccine booster should be based on the type of vaccine previously received (after the Pfizer and Moderna messenger RNA [mRNA] primary vaccine series: ≥5 months; after the adenovirus-vectored Johnson & Johnson/Janssen COVID-19 vaccine: ≥2 months).

·   All patients with RMDs, with or without a history of previous SARS-CoV-2 infection, should be strongly advised to receive the primary, supplemental, and booster COVID-19 vaccine doses.

·   Based on approval by the US Food and Drug Administration (FDA) or Emergency Use Authorization (EUA), pre-exposure prophylaxis monoclonal antibody treatment may be recommended for patients with high-risk AIIRDs (defined as moderate or severe disease with an inadequate response to COVID-19 vaccination). Patients with AIIRDs with high risk for poor COVID-19-related outcomes may also receive monoclonal antibody therapy for COVID-19, if antibody therapy is indicated.

·   The ACR noted that no changes in immunomodulatory therapy and vaccination timing may be required for patients receiving intravenous immunoglobulins (IVIGs).

Reference

American College of Rheumatology. COVID-19 vaccine clinical guidance summary for patients with rheumatic and musculoskeletal diseases. Updated February 2, 2022. Accessed February 4, 2022. https://www.rheumatology.org/Portals/0/Files/COVID-19-Vaccine-Clinical-Guidance-Rheumatic-Diseases-Summary.pdf