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Review
. 2023 Dec 4;11(12):1813.
doi: 10.3390/vaccines11121813.

COVID-19 Vaccination and Immunosuppressive Therapy in Immune-Mediated Inflammatory Diseases

José M Serra López-Matencio  1 , Esther F Vicente-Rabaneda  2 , Estefanía Alañón  1 , Ainhoa Aranguren Oyarzabal  1 , Pedro Martínez Fleta  3 , Santos Castañeda  2
Affiliations
Review

COVID-19 Vaccination and Immunosuppressive Therapy in Immune-Mediated Inflammatory Diseases

José M Serra López-Matencio et al. Vaccines (Basel). .

Abstract

The COVID-19 vaccination program has probably been the most complex and extensive project in history until now, which has been a challenge for all the people involved in the planning and management of this program. Patients with immune-mediated inflammatory diseases (IMIDs) on immunosuppressive therapy have required special attention, not only because of the particular haste in carrying out the process but also because of the uncertainty regarding their response to the vaccines. We now have strong scientific evidence that supports the hypothesis that immunosuppressive therapy inhibits the humoral response to vaccines against other infectious agents, such as influenza, pneumococcus and hepatitis B. This has led to the hypothesis that the same could happen with the COVID-19 vaccine. Several studies have therefore already been carried out in this area, suggesting that temporarily discontinuing the administration of methotrexate for 2 weeks post-vaccination could improve the vaccine response, and other studies with various immunosuppressive drugs are in the same line. However, the fact of withholding or interrupting immunosuppressive therapy when dealing with COVID-19 vaccination remains unclear. On this basis, our article tries to compile the information available on the effect of immunosuppressant agents on COVID-19 vaccine responses in patients with IMIDs and proposes an algorithm for the management of these patients.

Keywords: COVID-19; DMARDs; biological drugs; immune-mediated inflammatory diseases (IMIDs); immunosuppressive therapy; targeted synthetic DMARDs; vaccination.

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Conflict of interest statement

S. Castañeda received grants/research support from MSD, Pfizer and UCB, and consultation fees in company-sponsored speaker’s bureau from Amgen, BMS, Gedeon Richter, Lilly, MSD, Roche, Sanofi and UCB. S. Castañeda is an assistant professor at Cátedra UAM-Roche, EPID-Future, Universidad Autónoma de Madrid (UAM), Madrid, Spain.

Figures

Figure 1
Figure 1
Main factors that may influence the management of immunosuppressed a patient when designing a vaccination strategy for COVID-19. Footnotes: (cs)DMARDs: (conventional synthetic) disease-modifying antirheumatic drugs; IL: interleukin; JAK: Janus kinase; mo: month; MTX: methotrexate; TNF: tumor necrosis factor; wks: weeks. * Proposal of the authors considering the available bibliography. ** According to the ECDC (European Centre for Disease Prevention and Control) Technical Report: https://www.ecdc.europa.eu/sites/default/files/documents/COVID-19-vaccination-and-prioritisation-strategies.pdf (accessed on 10 October 2023). *** According to the Spanish government: https://www.mites.gob.es/ficheros/ministerio/contacto_ministerio/lista_actividades_esenciales.pdf (accessed on 10 October 2023) [82].
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