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Although it is difficult to generalise, people with systemic autoimmune diseases (SAD) are considered to be at increased risk of severe forms of disease and mortality due to COVID-19. On the one hand, the risk factors associated with greater severity are the same as those of the general population, for example being over 65, being male, or having high blood pressure, heart disease and chronic lung or kidney disease. On the other hand, there are factors inherent to SAD that contribute to greater severity and mortality due to COVID-19 amongst these patients, such as moderate to high disease activity, taking more than 10 mg/day of prednisone, or using rituximab (Ann Rheum Dis 2020; 79: 1544-1549).
Yes. There are currently three vaccines available (Pfizer, Moderna and AstraZeneca) that can be administered to patients with SAD. None of them contain the attenuated virus. We do not currently have efficacy and safety data for COVID-19 vaccines in people with SAD, because they were not included in clinical trials (only the Pfizer vaccine trial included patients with rheumatological diseases, and they accounted for less than 1% of the total number of people included).
Due to both the design of the vaccine and the way it generates antibodies against SARS-CoV-2, it is highly unlikely that administration of the vaccine will cause an SAD flare-up. There is no risk of serious adverse effects just because you have an SAD. All scientific societies consider COVID-19 vaccines to be safe, and the benefits of vaccination far outweigh the possibility of any potential serious adverse effects which, moreover, are very rare in people who do not have an SAD.
In general, all scientific societies are in agreement that treatment should not be stopped, as the risk of a flare-up is high. The argument in favour of doing so would be that the immunosuppressive treatment itself might decrease or hinder the generation of antibodies against SARS-COV-2. However, there is unanimous agreement that it is better to generate less than none at all.
As with other vaccines recommended for people with SAD, such as influenza or pneumococcus, you are advised to receive the vaccine when the disease is inactive or stable. In other words, if you are in the middle of a flare-up, it is best to treat it and delay administration of the vaccine.