COVID-19 and Third Dose (Booster) Vaccination Update
Updated August 23, 2021
Mid-America Rheumatology Consultants (MARC) has been following updates from the FDA, CDC, and American College of Rheumatology (ACR) regarding the recommendation for a third COVID-19 “booster” shot for immunocompromised patients. Last week the vaccine panel for the ACR released updated guidance. Below are the current recommendations. We are aware recommendations may have changed from what you were told if you had an appointment the past couple weeks. Please realize that this is a very dynamic situation and guidance does change as new information becomes available. We will continue to attempt to keep you updated with the most current recommendations.
Based on current recommendations, patients who have an autoimmune condition and take prednisone or glucocorticoids (equivalent to 20mg daily or more), immunomodulatory or immunosuppressive medication are eligible for a third dose of either the Pfizer or Moderna vaccine if it has been more than 28 days since your second vaccine dose. At present it is recommended that the third dose be the same type as what was originally given. If you received the one-dose Johnson & Johnson vaccine, it is not yet recommended to get a second dose.
If you have not yet been vaccinated, we encourage you to start your vaccinations as soon as possible (unless you have had a severe reaction to a previous immunization). As of 8/23/2021 the Pfizer vaccine is no longer under Emergency Use Authorization and is fully approved.
At this time, it is not required to have a letter for clearance to get the third dose. If you are asked for a letter, one can be provided to you.
Timing Considerations for the third/booster dose of the COVID-19 Vaccination:
**Please note – You should not stop your rheumatology medications if your autoimmune disease symptoms are not well controlled. We do, however, still encourage you to get the booster dose.
-If you take ibuprofen, naproxen, other NSAIDs, or Tylenol, and your rheumatologic disease is doing well, do not take them for 24 hours prior to vaccination (no restrictions on use post-vaccination).
-If disease activity is well controlled, do not take immunomodulatory or immunosuppressive treatment (oral, injections, infusions) for 1-2 weeks after the booster vaccination. If you start to experience a recurrence of your disease symptoms, resume your medications.
*The panel did not achieve a consensus on whether to hold cytokine inhibitors at the time of booster vaccination.
Cytokine inhibitors: Actemra (tocilizumab), Cosentyx (secukinumab), Ilaris (canakinumab), Kevzara (sarilumab), Kineret (anakinra), Skyrizi (rizankizumab), Stelara (ustekinumab), Tremfya (guselkumab).
-Do not stop or lower your prednisone (or glucocorticoid) dose unless instructed to do so by your physician.
-If you take Rituxan (rituximab), contact MARC regarding when you should schedule the vaccine and rituximab infusion.
For recommendations regarding the timing of Dose #1 and #2 of COVID vaccinations, please refer to our August 13, 2021 post below.
COVID-19 and Vaccination Update
Updated August 13, 2021
Mid-America Rheumatology Consultants (MARC) has been following the Centers for Disease Control and Prevention (CDC) and U.S. Food and Drug Administration (FDA) for new recommendations regarding COVID-19 booster shots for immunocompromised patients. On August 12, 2021 the FDA amended the emergency use authorizations (EUAs) for both Pfizer-BioNTech COVID-19 Vaccine and the Moderna COVID-19 vaccine to allow for the use of an additional dose in certain immunocompromised individuals, specifically, solid organ transplant recipients or those who are diagnosed with conditions that are considered to have an equivalent level of immunocompromise. The CDC’s Advisory Committee on Immunization Practices (ACIP) is scheduled to meet Friday, August 13, 2021 to discuss further clinical recommendations regarding immunocompromised individuals.
We are also awaiting guidance from the American College of Rheumatology (ACR) pertaining to the timing of the booster vaccine, specific medication use or conditions in which a booster vaccine is recommended, and if patients should get the same brand of vaccine they received for the initial vaccination or a different brand.
As we await clearer guidance from the FDA, CDC/ACIP, ACR, and other relevant organizations, we cannot currently give a recommendation for our patients to get a booster dose of the COVID-19 vaccine. We wanted to make you aware of this before you call our office to inquire. You will get the same answer. We are actively monitoring for updates and will post these when we learn more.
As per past guidance, MARC physicians strongly encourage our patients to obtain any of the currently available COVID-19 vaccines in the U.S. if they have not yet received it. Based on the data for the COVID-19 vaccines in the U.S., there is no preference for one vaccine over another.
The ACR recommends that healthcare providers should not routinely order any lab testing (e.g., antibody tests for IgM and/or IgG to spike or nucleocapsid proteins) to assess immunity to COVID-19 in vaccinated or on vaccinated patients. Please do not contact our office with a request for this type of testing. Thank you for your cooperation.
We support the clinical guidance from the ACR (2/10/2021) and subsequent updates (latest 8/4/2021) regarding how to take various medications around the time of COVID-19 vaccinations that use mRNA (Pfizer and Moderna).
CLICK HERE for Vaccine and Medication Guidance
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If you take ibuprofen, naproxen, other NSAIDs, or Tylenol, and your rheumatologic disease is doing well, do not take them for 24 hours prior to vaccination (no restrictions on use post-vaccination).
If you take any of the following medications, and your rheumatologic disease is doing well, do not take this medication for 1 week after each dose of the COVID-19 vaccine:
Xeljanz (tofacitinib)
Rinvoq (upadacitinib)
Olumiant (baricitinib)
If you take methotrexate or mycophenolate (CellCept, Myfortic), and your rheumatologic disease is doing well:
Do not take methotrexate and mycophenolate (Cellcept, Myfortic) for 1 week after each of the mRNA vaccine doses (Pfizer, Moderna)
Do not take methotrexate for 2 weeks after single-dose vaccine (Johnson & Johnson)
If you take the following medications, contact MARC regarding when you should schedule the doses:
Orencia (abatacept)
Rituxan (rituximab)
Cyclophosphamide intravenous (IV) only (Cytoxan)
If you take the following medications, you do not need to alter medication dosing around timing of the COVID-19 vaccination:
Actemra
Guselkumab (Tremfya)
Sarilumab (Kevzara)
Adalimumab (Humira)
Secukinumab (Cosentyx)
Anakinra (Kineret)
hydrocortisone
Simponi
Apremilast (Otezla)
Hydroxychloroquine (Plaquenil)
Simponi Aria
Arava (leflunomide)
Ilaris
Skyrizi
Azathioprine (Imuran)
Imuran
Stelara
Belimumab (Benlysta)
Infliximab (Remicade, Inflectra, Renflexis)
Sulfasalazine
Benlysta
Ixekizumab (Taltz)
Tacrolimus
Canakinumab (Ilaris)
Kevzara
Taltz
Certolizumab (Cimzia)
Kineret
Tocilizumab (Actemra)
Cimzia
Leflunomide
Tremfya
Cosentyx
Lupkynis
Ustekinumab (Stelara)
Cyclophosphamide oral only (Cytoxan)
Otezla
Voclosporin (Lupkynis)
cyclosporine
Prednisone
Zoledronic acid (Reclast)
Cytoxan (oral only)
Prolia
Denosumab (Prolia)
Reclast
Enbrel
Remicade
Etanercept (Enbrel)
Rizankizumab (Skyrizi)
Evenity
Romosozumab (Evenity)
Reference: American College of Rheumatology COVID-19 Vaccine Clinical Guidance Summary for Patients with Rheumatic and Musculoskeletal Diseases
For more information about coronavirus, visit the Centers for Disease Control and Prevention (CDC) website: