JointHealth™ express   March 31, 2021

Important COVID-19 vaccination information for New Brunswick arthritis patients

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 (Enbrel, Brenzys, 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.
Important update about the AstraZeneca COVID-19 vaccine

Effective March 29, 2021, the National Advisory Committee on Immunization (NACI) recommends that AstraZeneca COVID-19 vaccine should not be used in adults under 55 years of age at this time while the safety signal of Vaccine-Induced Prothrombotic Immune Thrombocytopenia (VIPIT) following vaccination with AstraZeneca COVID-19 vaccine is investigated further.

Read NACI’s statement here:

Dive deeper:

How to get your vaccination in New Brunswick:

Effective March 29, 2021, as part of the roll-out of the AstraZeneca/Covishield, the New Brunswick government has paused giving the vaccine to people under 55 but will continue using it for those over 55.

Starting in April, the vaccine roll out will now include:
  • Individuals between the ages of:
    • 70 to 74
    • 65 to 69
    • 60 to 64
  • Residents & staff of communal settings
  • Home Care Workers
  • Large employers (including public school system)
  • Extra-Mural patients (housebound / unable to travel)
Please note: Only call or book an appointment under this category if you meet the eligibility.

Before booking an appointment, you must review the list of select chronic medical conditions. At the time of your appointment you must present this signed declaration. (If you cannot print the declaration form, one will be available at the appointment to complete before you can receive a vaccine.)

Anyone self-identifying should be prepared to provide documentation, for example: the name of their Primary care provider, chronic care clinic they attend, prescriptions, upcoming appointments or other supporting information for selected chronic conditions.