JointHealth™ express   March 30, 2021

Important Manitoba patient information about the COVID-19 vaccination for people with inflammatory (or “autoimmune”) arthritis and on immunosuppression therapies

Although there is limited data from large population-based studies, it appears that patients with autoimmune and inflammatory diseases and conditions (such as rheumatoid arthritis, axial spondyloarthritis and lupus) are at a higher risk for developing COVID-19 that result in hospitalization compared to the general population. They also can have worse outcomes associated with the infection, most notably, an increased risk of death especially in those with poorly controlled disease and underlying complications related to their disease.

People living with forms of inflammatory arthritis have questions and concerns on whether they should take the COVID-19 vaccine. The Canadian Rheumatology Association (CRA) and the American College of Rheumatology have published evidence-based recommendations that the benefit of COVID-19 vaccination outweighs any small, possible risks for new autoimmune reactions or disease flare after vaccination, as well as advice on how to best include it into their treatment plans to maximize vaccine efficacy.

Here are the recommendations:

  1. All adult inflammatory arthritis patients should receive the COVID-19 vaccine unless there are known allergies to vaccine components. Patients on immune suppressing medications (such as those listed below) should receive the vaccine. The CRA does not recommend adjusting these medications; however, in individual cases, medication adjustment may be appropriate.

  2. There is no preference for one manufacturers’ vaccine over another.

  3. For inflammatory arthritis patients on the following medications, there is no need to adjust or delay the medication:
    • Anti-inflammatory medications (or “NSAIDs”)
    • Hydroxychloroquine (Plaquenil)
    • Prednisone less than 20mg/day
    • IVIG
    • Sulfasalazine
    • Leflunomide (Arava)
    • Mycophenolate (CellCept)
    • Azathioprine
    • Oral cyclophosphamide
    • Cyclosporin
    • Tacrolimus (Protopic)
    • Anakinra (Kineret)
    • Etanercept (Brenzys, Enbrel, Erelzi)
    • Infliximab (Avsola, Inflectra, Remicade, Renflexis)
    • Certolizumab (Cimzia)
    • Golimumab (Simponi)
    • Adalimumab (Humira)
    • Secukinumab (Cosentyx)
    • Ustekinumab (Stelara)
    • Sarilumab (Kevzara)
    • Tocilizumab (Actemra)
    • Belimumab (Benlysta)
    • Ixekizumab (Taltz)
  4. For patients on the following medications, there are two options:

    Option 1:
    Do not change medication dosing (Canadian Guidelines).

    Option 2:
    Adjust medication dosing to optimize the immune response to the vaccine (American Guidelines). For this option, the guidelines make the following medication specific recommendations:
    • For patients on weekly methotrexate, an option is to skip the MTX dose the following week after each vaccine dose.
    • For patients on tofacitinib, baricitinib, upadacitinib, an option is to skip the medication for 1 week following each vaccine dose.
    • For patients on abatacept weekly injections, an option is to skip the abatacept one week before and one week after the first dose of vaccine. Continue abatacept through the second dose of vaccine. For IV abatacept, consider timing the 1st dose of vaccine 4 weeks post dose and postpone next infusion x 1 week. No IV Abatacept adjustments needed for 2nd vaccine dose.
    • For patients on IV cyclophosphamide, an option is to take each vaccine dose at least 1 week prior to the next cyclophosphamide infusion.
    • For patients on rituximab (Rituxan, Ruxience, Riximyo, Truxima) or ocrelizumab, the COVID-19 vaccination should ideally be timed 4-5 months after your last infusion and 2-4 weeks prior to their next infusion, when possible, in order to optimize vaccine response. However, in patients who require immediate infusion or who are unable to optimize timing of infusion product and vaccine, it is likely more important to have the COVID vaccine earlier than to delay based on timing of B-cell therapy.
    • For patients on prednisone 20mg/d or higher, consider waiting until the prednisone dose is tapered to below 20mg/d to receive both vaccine doses.
  5. How to get your vaccination:

    Effective March 29, 2021, as part of the piloted roll-out of the AstraZeneca/Covishield, Manitobans aged 55 to 64 years (First Nations people aged 55 to 64) with a high-risk condition will be the first group eligible to receive the AstraZeneca/Covishield COVID-19 vaccine.

    People with high-risk conditions (as determined by their doctor or pharmacist) will be prioritized, with those who have a condition in Priority List 1 being offered immunization before those with a condition in Priority List 2.

    Included in Priority List 1 are people receiving one or more of the following immunosuppressive therapies: B cell therapies (e.g., rituximab, ocrelizumab), chronic dose prednisone >=20mg/day, sulfasalazine and JAK inhibitors (e.g., tofacitinib).

    Included in Priority List 2 are
    • people living with chronic health conditions, including severe systemic autoimmune disorders (e.g., systemic lupus erythematosus, rheumatoid arthritis)
    • people receiving immunosuppressing therapy
    For further information, please visit the Manitoba government website

The AstraZeneca/COVISHIELD vaccine doses will primarily be used to provide COVID-19 vaccines in doctors’ offices and pharmacies. Manitoba public health officials have developed guidance for the use of the AstraZeneca/Covishield vaccine. This information is being shared with providers and posted online to guide how appointments are booked once the vaccine is available in Manitoba clinics and pharmacies.

Book your COVID-19 vaccine appointment online

If you are eligible to be immunized, you can now book your vaccine appointment online for any Government supersites, quickly and conveniently.

To book, you'll need to create an account with your email address and health card number. You can link more than one person to the same account, so that you can book for family members and loved ones as they become eligible. Please note that only first-dose appointments should be booked at this time.

Book your COVID-19 vaccine appointment online.

Once you have booked an appointment, don’t forget to print and complete your consent form.

If you don't have an email address, the call centre continues to be available at 1-844-626-8222 (1-844-MAN-VACC) to book appointments at supersites and pop-up clinics. Daily hours of operation are from 6:00 a.m. to 8:00 p.m.

Only individuals who are eligible can call or book an appointment online for immunization. You will be screened to ensure you meet current eligibility.

1Canadian Rheumatology Association Recommendation on Covid-19 Vaccination in Persons with Autoimmune Rheumatic Disease. February 2021
2American College of Rheumatology Covid-19 Vaccine Clinical Guidance Summary for patients with Rheumatic Disease. February 8, 2021