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Not All Immunosuppression Alters Vaccine Immunogenicity

Jack Cush, MD

Chronic inflammatory disease (CID) patients are urged to receive the COVID-19 vaccines; but when a cohort of CID patients treated with immunosuppressive medications were given an mRNA-based SARS-CoV-2 vaccination, only those treated with glucocorticoids and B cell depleting therapies (B

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RheumNow Podcast – COVID Marching Amidst the Madness (8.27.2021)

Jack Cush, MD

We have a lot of news, information and approvals to review and discuss, though I need to begin with what's weighing heavily on my mind. After, we'll dive into what we learned this week.

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Rare Risks Associated with BNT162b2 mRNA Covid-19 Vaccine

Jack Cush, MD

The current NEJM reports that the use of the Pfizer mRNA vaccine (BNT162b2) demonstrated a very low risk for certain serious adverse events, including the risk of myocarditis (1 to 5 events per 100,000 persons). 

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ACR Guidance on Timing of 3rd Dose Booster with Immunomodulatory Drugs

ACR Press Release

The American College of Rheumatology has issued an updated version of its COVID-19 Vaccine Clinical Guidance for Patients with Rheumatic and Musculoskeletal Diseases following recent recommendations from the CDC that certain immunocompromised patients receive a third dose of an availabl

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Lancet: 1276 Wuhan hosp COVID-19 pts studied at 6 & 12 mos. 68% & 49% had at least 1 COVID Sx at 6 & 12 mos. 12 mos sxs: SOB (30%), depression(26%), pain & mobility. Women had more fatigue/weak (OR 1.43), anx/depression (2·0), diffusion impairment (2·97) https://t.co/A8STTYiHq5 https://t.co/J4JoKFa00K

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Dr. John Cush RheumNow ( View Tweet)
Octave study examined COVID-19 Vax Ab responses in 600 immunocompromised-IMC (Cancer, IMID) pts. Compared to normals, fewer IMC seroconverted @4 wks (89 vs 100%). 40% of IMC had a low Ab resp; 11% of IMC had zero Ab response https://t.co/11VkeNKzvL

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Dr. John Cush RheumNow ( View Tweet)

NIAID will study COVID‐19 Booster Vaccine in Autoimmune Disease Non‐Responders (including MS, RA, SLE, Scleroderma,pemphigus); 20 sites, 600 pts (taking MTX, MMF or RTX) w/ poor resp to mRNA vax & recv 3rd booster vax. https://t.co/YwCvGnX21F https://t.co/th2WoRv1ng

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Dr. John Cush RheumNow ( View Tweet)

We've got another resource available on Cytokine Storm Management. Log in and download today. https://t.co/dTAzMVa6SB https://t.co/BvsZFxGrQl

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Dr. John Cush RheumNow ( View Tweet)
The current NEJM reports that the use of the Pfizer mRNA vaccine (BNT162b2) demonstrated a very low risk for certain serious adverse events, including the risk of myocarditis (1 to 5 events per 100,000 persons). https://t.co/CT4dQK9XlH https://t.co/enddiHtX1G

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Dr. John Cush RheumNow ( View Tweet)
Si @DGlaucomflecken es el mejor se dice y ya está https://t.co/QzPyIe5gAA
Raruniente Raruniiente ( View Tweet)
New podcast available for download! COVID Marching Amidst the Madness https://t.co/xYzkw3zGRt https://t.co/gv45nVk9v5

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Dr. John Cush RheumNow ( View Tweet)
ACR Guidance on Timing of 3rd Dose Booster with Immunomodulatory Drugs https://t.co/XO4DPXwGQi https://t.co/S9E3yENfDF

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Dr. John Cush RheumNow ( View Tweet)
2021–22 influenza season coincides with continued COVID infx & Sxs may be confused betw both. ACIP Influenza vaccination guidelines: 1. Annual flu vaccine rec to all >6mos; 2. COVID Vax can be given w/ Flu Vax; 3. give before Nov 2021 https://t.co/oIkl50GI0W

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Dr. John Cush RheumNow ( View Tweet)

Comparing COVID vaccines in rheum dz pts - 45 took J&J vax compared to 994 on mRNA vaccines. Detectable Ab responses lower w/ J&J (80% vs 92%, p=0.03) than mRNA vax. RTX, MMF & steroids significantly depressed Ab responses https://t.co/6ZJU8EVF5n

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Dr. John Cush RheumNow ( View Tweet)

MTX impairs COVID Vax responses in IMID pts from Ehrlangen & NYU. BNT162b2 mRNA COVID-19 vaccination in rheumatic pts (82) & 206 controls. Adequate immunogenicity seen in IMID & TNFi Rx >90%, but less (50-72%) w/ MTX (45) https://t.co/EvxZSAD6ve

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Dr. John Cush RheumNow ( View Tweet)

#ClinicalPearl My pt’s rheumatoid nodules ⬇️ when she continued off her #methotrexate post #CovidVaccine. She restarted her JAKi + #plaquenil https://t.co/FqNX9k7FUN
Janet Pope Janetbirdope ( View Tweet)
In the land of a surfeit of free vaccines, this is the dark day when we crossed the line of over 100,000 hospitalizations, more than 25,000 patients in the ICU (highest for the pandemic), over 1300 deaths, and over 186,000 new cases. https://t.co/A8KNIClCwX
Eric Topol EricTopol ( View Tweet)
Given the DELTA breakthrough surge how do you feel about live medical meetings (n> 50) in the next 6 weeks @Janetbirdope @KDAO2011 @psufka @AngusWorthing @RonanTKavanagh @RheumNow @MattieRheumMD @rheum_cat @jeffsparks @hausmannMD @CCalabreseDO @DrSwamyV

Leonard Calabrese LCalabreseDO ( View Tweet)

Among pregnant women, receipt of the BNT162b2 vaccine was associated with a 78% lower risk of incident SARS-CoV-2 infection. Cohort study tincluded 15 060 pregnant women in Israel. No adverse pregnancy outcome difference in Vax Pts https://t.co/jXUjaKIfUV

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Dr. John Cush RheumNow ( View Tweet)

CDC: LA county breakthrough COVID infections: In 43,000 new COVID, 10,895, or 25.3%, occurred in fully vaccinated persons, 1,431, or 3.3%, were in partially vaccinated persons, and 30,801, or 71.4%, were in unvaccinated individuals. https://t.co/gbgaV7THch

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Dr. John Cush RheumNow ( View Tweet)

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