- Almost 3% of US insureds under the age of 65 take drugs that suppress the immune system.
- The widespread use of these drugs is problematic as they can reduce the effectiveness of COVID-19 vaccination.
- Experts suggest that changing the timing of medications or giving these patients booster shots may help avoid this problem.
- However, it is advisable to get vaccinated because the vaccine has some protective effect.
- Patients with immunodeficiency are advised to continue precautions such as hand washing and physical distance after vaccination.
Researchers in Michigan medicine have found that nearly 3 percent of US adults under the age of 65 are taking the following medications:
This is important because taking these medications may increase the risk of COVID-19 symptoms and hospitalization if infected with the virus.
There is also increasing evidence that these drugs may reduce the effectiveness of COVID-19 vaccination.
First author Dr. Beth WallaceRheumatologists in Michigan medicine said immunosuppressive drugs are usually used to treat conditions that have an inappropriate immune response that can damage certain parts of the patient’s own body.
Examples of these types of conditions include autoimmune diseases such as rheumatoid arthritis and lupus, which cause the immune system to consider certain parts of the patient’s own body, such as joints, as a threat, she said.
When the patient’s immune system begins to attack these parts of the body, it can cause damage.
Immunosuppressive drugs can be used to reduce this attack on the patient’s own tissues.
Wallace said another case in which people may be using immunosuppressive drugs was when they received an organ transplant. In this case, the drug is used to prevent the immune system from attacking the transplanted organ as an invader.
In addition, certain types of chemotherapy used to kill cancer cells can have the side effect of suppressing the immune system.
Wallace said most of these immunosuppressive drugs are not used outside of people with these chronic illnesses. However, one type of immunosuppressive drug that is very commonly used is steroids.
Steroids include drugs such as prednisone and dexamethasone.
These drugs may be given in the short term for symptoms such as allergic rashes, bronchitis, and sinus infections.
“This is a problem,” Wallace explained. “Because steroids are highly immunosuppressive. Even short courses and low doses of steroids can increase people’s risk of infection and reduce their response to vaccines such as the COVID vaccine. I’m learning more and more. “
“Vaccines work by teaching the immune system to recognize a particular threat, allowing it to respond appropriately when the threat is revisited,” Wallace said.
However, according to Wallace, immunosuppressive drugs work by reducing the ability of the immune system to recognize and repel threats.
This suppression helps treat autoimmune conditions such as rheumatoid arthritis where an unwanted immune response is occurring.
“But immunosuppression also reduces the ability of the immune system to respond to what you want to react to, such as infections and vaccines,” she said.
“People taking immunosuppressive drugs are beginning to realize that they are slow to respond to COVID vaccination and may be weak.”
Experts say there may be strategies that can be used to avoid the problems posed by immunosuppression.
Wallace suggested that medication could be suspended by the time vaccination was given, or the infusion could be delayed until there was time to initiate an immune response to the injection.
Dr. Megan BakerHospital epidemiologists dealing with immunocompromised patients at the Dana-Farber Cancer Institute and Brigham and Women’s Hospital recommend that experts complete the COVID-19 vaccine series at least two weeks in advance if the timing of immunosuppressive therapy is flexible. He added that he often does. Start dosing.
However, if this is not possible, it is recommended that the patient consult with his doctor about the risks and benefits of delaying treatment.
Wallace further explained that certain immunosuppressive drug timing recommendations need to be tailored to individual needs.
“For example, if someone is receiving chemotherapy to treat active cancer, the risk of temporarily stopping that treatment is that someone has been taking it for 10 years to treat stable rheumatoid arthritis. It’s very different from the risk of stopping the drug, “Wallace said.
She also pointed out that different immunosuppressive drugs can have different effects on the vaccine response.
“Therefore, the guidelines that make sense for a particular condition or medication may not be appropriate for others,” she explained.
In addition to changing the timing of dosing, Wallace has “several studies examining the effects of” booster shots “in this population. It is given in addition a few months after the person was first vaccinated. “
Baker said that in general, people receiving immunosuppressive therapy can and should be vaccinated.
“The protective effect may vary depending on the underlying disease and immunosuppressive therapy, but most people get some protection from the vaccine,” Baker said. “If you get infected, you can reduce your chances of getting infected or developing a serious illness.”
“People with immunodeficiency are advised to continue to use precautions to minimize exposure to SARS-CoV-2, as the effectiveness of the vaccine may be reduced.” She added.
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