Recommendations for COVID‐19 vaccination in people with rheumatic disease: Developed by the Singapore Chapter of Rheumatologists

  1. Amelia Santosa
  2. Chuanhui Xu
  3. Thaschawee Arkachaisri
  4. Kok Ooi Kong
  5. Aisha Lateef
  6. Tau Hong Lee
  7. Keng Hong Leong
  8. Andrea Hsiu Ling Low
  9. Melonie K. Sriranganathan
  10. Teck Choon Tan
  11. Gim Gee Teng
  12. Bernard Yu‐hor Thong
  13. Warren Fong
  14. Manjari Lahiri

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Abstract

Aim

People with rheumatic diseases (PRD) remain vulnerable in the era of the COVID‐19 pandemic. We formulated recommendations to meet the urgent need for a consensus for vaccination against SARS‐CoV‐2 in PRD.

Methods

Systematic literature reviews were performed to evaluate: (a) outcomes in PRD with COVID‐19; (b) efficacy, immunogenicity and safety of COVID‐19 vaccination; and (c) published guidelines/recommendations for non‐live, non‐COVID‐19 vaccinations in PRD. Recommendations were formulated based on the evidence and expert opinion according to the Grading of Recommendations Assessment, Development and Evaluation methodology.

Results

The consensus comprises 2 overarching principles and 7 recommendations. Vaccination against SARS‐CoV‐2 in PRD should be aligned with prevailing national policy and should be individualized through shared decision between the healthcare provider and patient. We strongly recommend that eligible PRD and household contacts be vaccinated against SARS‐CoV‐2. We conditionally recommended that the COVID‐19 vaccine be administered during quiescent disease if possible. Immunomodulatory drugs, other than rituximab, can be continued alongside vaccination. We conditionally recommend that the COVID‐19 vaccine be administered prior to commencing rituximab if possible. For patients on rituximab, the vaccine should be administered a minimum of 6 months after the last dose and/or 4 weeks prior to the next dose of rituximab. Post‐vaccination antibody titers against SARS‐CoV‐2 need not be measured. Any of the approved COVID‐19 vaccines may be used, with no particular preference.

Conclusion

These recommendations provide guidance for COVID‐19 vaccination in PRD. Most recommendations in this consensus are conditional, reflecting a lack of evidence or low‐level evidence.

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  1. Version published to 10.1111/1756-185x.14107
  2. ScreenIT

    SciScore for 10.1101/2021.03.01.21252653: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.
    Cell Line Authenticationnot detected.

    Table 2: Resources

    Experimental Models: Cell Lines
    SentencesResources
    A modified Delphi approach, similar to what has been applied by other organizations, was used13,14 The TFP (TA, KOK, AL, THL, KHL, AHLL, MKS, TCT, GGT, BYT) comprised eight locally recognized adult rheumatologists from public and private healthcare institutions in Singapore, one paediatric rheumatologist and one infectious diseases specialist.
    TA
    suggested: RRID:CVCL_4315)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: An explicit section about the limitations of the techniques employed in this study was not found. We encourage authors to address study limitations.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

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  3. Version published to 10.1101/2021.03.01.21252653v2 on medRxiv
  4. Version published to 10.1101/2021.03.01.21252653v1 on medRxiv