Updates to American College of Rheumatology's COVID-19 Vaccine Guidelines for RMD

The American College of Rheumatology (ACR) has updated its “COVID-19 Vaccine Clinical Guidance Summary for Patients with Rheumatic and Musculoskeletal Diseases.”

This newest update includes recommendations, such as timing considerations, that differentiate supplemental and booster doses for people with rheumatic and musculoskeletal diseases (RMDs).

“No evidence was found to support a concern regarding the use or timing of immunomodulatory therapies in relation to vaccine safety,” the update said. “Therefore, guidance regarding immunomodulatory medication and vaccination timing was given considering the intent to optimize vaccine response.”

The updated recommendations include the following revisions and additions:

• Patients with autoimmune inflammatory rheumatic diseases (AIIRDs) who have received their primary COVID-19 vaccine series and will likely have an inadequate vaccine response should receive a supplemental or third dose, according to CDC recommendations for immunocompromised individuals
• Patients with RMDs who have received their primary COVID-19 vaccine series and qualifying supplemental doses should also receive a booster dose or multiple booster doses, per the CDC
• Patients with RMDs should receive their initial, supplemental, and booster doses regardless of previous COVID-19 infection
• Patients with AAIRD who are considered high risk should receive pre-exposure prophylaxis monoclonal antibody treatment when available, but only if approved or licensed by the FDA under an emergency use authorization (EUA)
• Patients with AAIRD who are considered to be at high risk for poor COVID-19–related outcomes should receive monoclonal antibody therapy, only if approved or licensed by the FDA under an EUA; those recently exposed would receive the treatment as a preventive method and those with new-onset COVID-19 as an actual treatment

Regarding the use and timing of vaccine doses, the ACR said no modifications to either immunomodulatory therapy or vaccination timing are currently required for patients receiving intravenous immunoglobulins (IVIGs). However, the update does include notice of the revoked EUA status of 2 COVID-19 monoclonal antibody treatments: bamlanivimab with etesevimab (Eli Lilly) and casirivimab with imdevimab (REGEN-COV; Regeneron). In January 2022, the FDA significantly restricted use of these treatments, citing scientific evidence showing their ineffectiveness against the Omicron variant.

No changes were made to the general considerations on COVID-19 vaccination for patients with RMDs. Based on current evidence as of this fifth update, the expected benefits outweigh the potential for harm of COVID-19 vaccination for patients with RMDs .

“The future COVID landscape is uncertain with respect to vaccine effectiveness and safety, uptake, durability, mitigating societal behavior, and emerging viral strain variants,” the ACR COVID-19 Vaccine Clinical Guidance Task Force said in the update. “Clinicians nevertheless must act with their best judgement despite this highly uncertain and rapidly changing landscape.”

Reference

Curtis JR, Johnson SR, Anthony DD, et al. American College of Rheumatology guidance for COVID-19 vaccination in patients with rheumatic and musculoskeletal diseases – Version 5. American College of Rheumatology. Updated February 2, 2022. Accessed February 8, 2022. https://www.rheumatology.org/Portals/0/Files/COVID-19-Vaccine-Clinical-Guidance-Rheumatic-Diseases-Summary.pdf