Researchers have established that the vaccines against SARS-CoV-2 work very well. They rev up the immune system to recognize the virus. Then immune cells go into action, producing antibodies and preventing most infections. Last week we asked the question: How safe are immune-modulating drugs during COVID-19? This week we get an answer and learn that some medications do reduce vaccine effectiveness. Others do not.
Researchers Determine Which Drugs Reduce Vaccine Effectiveness
For months, doctors have been wondering whether the coronavirus vaccines protect immunosuppressed individuals. Now a study published in Annals of Internal Medicine (Aug. 31, 2021) suggests that they do, depending upon the medications being used to dampen the immune system.
The investigators recruited 133 patients with chronic inflammatory diseases (CIDs). These ranged from rheumatoid arthritis and inflammatory bowel disease to lupus and multiple sclerosis.
There were also 53 healthy people to serve as controls. All the participants submitted blood samples before and after getting the Pfizer or Moderna vaccine.
Prednisone Did Reduce Vaccine Effectiveness:
Patients with chronic inflammatory diseases often receive drugs like corticosteroids (prednisone, prednisolone and methylprednisolone). Other immunosuppressive medications include B-cell depleting therapy (BCDT) such as ocrelizumab (Ocrevus) and rituximab (Rituxan).
Both corticosteroids (aka glucocorticoids) and the BCDT may reduce vaccine effectiveness. The researchers conclude that:
“We also found that participants receiving glucocorticoids had lower antibody titers after SARS-CoV-2 vaccination… Thus, future studies are needed to determine whether tapering of prednisone, with or without initiation of additional therapies, can promote optimal antibody responses from mRNA-based vaccines.”
These people are at high risk of complications if they contract COVID-19. Their lower levels of antibodies have led the CDC to recommend a third shot for patients on such strong immune-suppressing drugs.
Some Drugs That Do Not Reduce Vaccine Effectiveness:
All the healthy volunteers and approximately 90 percent of those taking immune suppressing drugs made measurable levels of antibodies against SARS-CoV-2. People on methotrexate or TNF inhibitors such as Enbrel, Humira or Remicade did as well as the control group. That is a great relief since many people are taking these immune modulators to control conditions like rheumatoid arthritis or psoriasis.
The bottom line seems to be that some immune modulators can reduce vaccine effectiveness. Prednisone and its close chemical cousins may pose a problem in this regard. Anyone on such medications should check with the prescriber to see if a booster shot would be advisable.
Annals of Internal Medicine, Aug. 31, 2021