COVID-19 vaccine effects on immune-mediated inflammatory diseases should be understood
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Dermatologists should be prepared to discuss COVID-19 vaccines with their patients who have immune-mediated inflammatory diseases and how biologic treatments may be affected, according to a review.
“Biologics have revolutionized therapy for immune-mediated inflammatory diseases (IMIDs), including many dermatologic diseases. While these drugs generally have a more favorable side effect profile than conventional immunosuppressive medications, depending on their mechanism these therapies cause some degree of immune suppression,” Sarah Wack, BS, and colleagues wrote in the Journal of the American Academy of Dermatology. “The implications of this have been important in helping patients navigate their treatment options during the COVID-19 pandemic.”
The review discussed evidence for vaccination in patients with IMIDs and COVID-19 vaccination recommendations to assist dermatologists.
There are currently two mRNA vaccines and one adenovirus-based vaccine approved for emergency use in the United States. For patients with IMIDs, the mRNA vaccines may trigger an inflammatory response, while the adenoviral vector vaccine may carry a rare risk for thrombosis.
Those on B-cell-depleting biologic therapies have had the most significant reduction in immune response to the vaccines, according to the review. Those on TNF inhibitors, IL-17 inhibitors or IL-12/13 inhibitors have had significantly less immune response to the vaccines.
Despite risks and immune responses, the COVID-19 vaccine is recommended for patients with IMIDs.
“Based on the available data, the chief concern for patients with IMID appears to be the efficacy of the immune response these patients will be able to generate, depending on the specific biologic therapy and indication being treated,” the authors wrote.
Dermatologists who treat patients with IMIDs should be well versed in the possible impacts of the COVID-19 vaccines, available data on vaccine studies and any possible contraindications.
“With COVID-19 vaccines becoming widely available, dermatologists need to be prepared to discuss risks and benefits of vaccination with their patients with IMID,” they wrote. “It is essential that we continue to follow patients with IMID after vaccination to determine vaccine safety, efficacy and duration in this population.”