Dr. W. Winn Chatham of UAB updates the group on the COVID booster for those who are immune compromised, based on the protocols at his institution.
Good evening and welcome to tuesday night with this club with us tonight is dr wynn chatham to talk a little bit about the coven vaccine booster before we start our presentation on parenting and lupus dr chatham thank you for joining us okay um just a quick update that’s come out in the last week the um fda with the cdc’s ascent has come out with another use
Authorization for a third dose of vaccine for patients that have underlying immunosuppression or significant immune deficiency so this will impact a lot of the lupus patients who um many of whom are on what they’re considering the immunosuppressive therapy in terms of who are they wanting to target with this third dose so most of the experience with the current
Pfizer vaccine is where most of the data is because that was the first one that came out but for people who are not immune suppressed we know that the tighter of the antibody protective antibody to the covet 19 spike viruses will decrease over time such that after about six months the titers are about half what they were one month post-immunization for patients
On immunosuppressive therapy there is some increasing evidence that those patients don’t make as high a titer to the antibody when they receive their initial uh first two doses of that vaccine and the same is applicable to the moderna vaccine as well although there’s just not as much data for that in this regard as there has been with the pfizer vaccine there’s
Probably even less data with the johnson johnson vaccine which is a single dose vaccine but most patients have gotten either the cd or the pfizer or the modern vaccine and so this is what this particular guidance addresses so uh bottom line is if you are on uh and i’ll try to relate this to the therapies we use in lupus but if you are currently been taking rehab
In recent months particularly after the time you got vaccinated either azathioprine mycophenolate mycophenolic acid or in dose with cyclophosphamide all those would be considered immunosuppressive therapies and it’s recommended that you go ahead now to get a third dose of the vaccine provided uh you got the first two doses at least a month ago you’re provided you
Got the second dose of either those vaccines at least one month ago because there’s evidence now that that third dose may actually increase the likelihood that you’ll attain protective titers it will last as long as we’d like for it too other therapies that lupus patients use such as hydroxyphoric one and probably the mister burlingman probably would not apply
To this immunosuppressive consideration because those are really considered more immunomodulatory drugs we talked about this a little bit a couple weeks ago the difference between those two but those particular treatments we know don’t really impair vaccine responses so at this point it’s not necessary to get a third dose however once six to eight months have
Elapsed since you received the second dose of those vaccines uh i anticipate that there’s going to be an additional authorization coming out for patients without immunosuppressive therapy to get a third dose of vaccine because of the waning of titer that i alluded to earlier other medications that lupus patients may be on that would apply to the immunosuppressive
Category uh would probably be leflunamide if you’re on that that would probably be considered in this immunosuppressive group where you should get a third dose of vaccine methotrexate probably you could consider you if you’re interested in getting a third dose now you could do that if you have that that would probably at least on paper qualify you most of the
Doses of methotrexate we use are probably more anti-inflammatory than they are immune suppressive however if you happen to get the first two doses of vaccine while you were taking methotrexate we know that methotrexate can attenuate your ability to respond to a vaccine so while they may not while methotrexate may not impair your ability to respond to the virus if
You’ve been previously vaccinated like some of these other immunosuppressants can uh if you got vaccinated while on methotrexate and didn’t hold it around the time of the immunization chances are very likely that you didn’t face i think you definitely should get a third dose of vaccine this time around being sure you hold the methotrexate at least a week before
Dosing as i was saying it’s more of an anti-inflammatory drug than an immune suppressive drug at the doses that are used in lupus patients so uh it should not impair your ability to mount a good response to the virus if you get infected but if you got vaccinated while taking methotrexate we know that methotrexate can impair your ability to respond to a vaccine
If you get vaccinated while taking it so if that applied to you you should definitely go ahead and get the third dose of vaccine this time around holding the methotrexate at least a week before you get this third dose of vaccine and not resuming the methotrexate until two weeks have passed since you got dosed um those are the main ones we worry about rituximab is
The other one so if you’ve been on rituximab as part of your treatment that would be another situation where you should definitely get a third dose of vaccine preferably after it’s been at least four to five months since you got the last dose of rituximab so if you just got rituximab a month ago if you get a vaccine dose now you’re probably not going to respond
To it i would wait at least three months before getting the third dose of vaccine orencia is another one if you got vaccinated while on orencia and didn’t hold it for the month before and after you should get a third dose of vaccine for sure again if when you get that third dose get it four weeks after your last torencia dose or hold the aurencia for at least
Several weeks before you dose and don’t resume it until a month has passed since you get received the vaccine and i can’t think of any others that we worry about but it’s mostly uh the immunos the you know the potent immunosuppressives like azathioprine mycophenolate mycophenolic acid cytokines and the two biologics that can definitely impair the vaccine response
Are arencia and with tuxenam and just remember if you’re on methotrexate you need to hold it a week before two weeks after getting any booster or third dose of vaccine if you’re on some of the trial drugs that are jack or tic-2 inhibitors it’s you should consider yourself uh on an immunosuppressant and get a third dose of vaccine we usually recommend that
You hold that drug a week or two after getting vaccinated just to enhance the likelihood of getting vaccinated but if you’re on a trial that’s something that needs to be discussed with trial managers because they don’t want you missing doses of growth so in that case that’s just something you would need to discuss with the trial manager the question is do you
Need to hold the azithioprine when you get vaccinated the acr is coming out with some guidance on that um in terms of what to do with those types of immune suppressive post-vaccination and i guess the consensus was to hold that for two weeks after the immunization again not a lot of data to inform that decision but the consensus opinion is it would be to prove
The likelihood that you have a good response would be to hold the azothiaprin same would apply to mycophenolate hold it for a couple weeks after the vaccine is administered to give yourself the best chance to respond and after two weeks then resume it right well dr chatham so the generally the best advice is to reach out to your own rheumatologist and do a good
Safety check yeah i mean i think that’s a good idea i mean at our call center we’ve kind of outlined this in terms of you know what we’re going to tell you when you call us so um we will uh usually just we have our staff inform the patient that if you’re taking this drug you should get the third dose now if you’re just taking plaquemine or just taking venlista
Or or the two of those together even it’s not necessary that you get a third dose of vaccine at this time you can wait until the six to eight months have passed when everybody else that’s not immunosuppressed is likely going to be uh recommended to get another dose of vaccine all right well dr chatham thank you so much for uh for jumping in with us tonight and
Taking the time we really appreciate it
Transcribed from video
081721 COVID Booster Info from Dr W Winn Chatham SD 480p By Lupus Mid-South