COVID-19 vaccination and antirheumatic therapy

The COVID-19 vaccination will be the largest vaccination programme in the history of the NHS. Patients on immunosuppressive therapy will be amongst the earliest to be vaccinated. Some evidence indicates immunosuppressive therapy inhibits humoral response to the influenza, pneumococcal and hepatitis B vaccines. The degree to which this will translate to impaired COVID-19 vaccine responses is unclear. Other evidence suggests withholding methotrexate for two weeks post vaccination may improve responses. Rituximab has been shown to impair humoral responses for 6 months or longer post administration. Decisions on withholding or interrupting immunosuppressive therapy around COVID-19 vaccination will need to be made prior to the availability of data on specific COVID-19 vaccine response in these patients. With this in mind, this article outlines the existing data on the effect of antirheumatic therapy on vaccine responses in patients with inflammatory arthritis and formulates a possible pragmatic management strategy for COVID-19 vaccination.