Background/Purpose: Due to concerns about underlying immune dysregulation and immunosuppression, patients with systemic rheumatic diseases (SRD) may have modified their medications at the time of COVID-19 vaccination to optimize their immune response. Although the American College of Rheumatology COVID-19 Vaccine Clinical Guidance Task Force issued management guidelines on February 8, 2021, it is unclear how rapidly these guidelines were disseminated. Our study evaluated real-world medication modification at the time of COVID-19 vaccination by Rheumatology patients at a single center in New York City.

Methods: We emailed a secure web-based survey to 7,505 patients aged ≥18 years evaluated at least once by a rheumatologist between April 1, 2018-April 21, 2020 at a large Rheumatology center in New York City. A follow-up survey was sent between March 5, 2021 and March 25, 2021. In the current analysis, we included individuals who indicated receiving at least the 1^st vaccine dose. We collected data on immunomodulatory and immunosuppressive medication usage and modifications at the time of COVID-19 vaccination. We also collected the source responsible for the medication modifications (i.e. rheumatologist, other physician, patient).

Results: 1852/7505 (24.7%) patients responded to vaccination and medication modification questions (mean age: 63±13.2 years, 79.6% female, 87.4% white, 4.8% Hispanic/Latinx). 1852 patients received at least 1COVID-19 vaccine dose (53.9% Pfizer, 44.3% Moderna, 1.4%% Janssen, 0.38% Other) and 1173 reported having two doses. At 1^st dose, there were 1373 individual reports of immunomodulatory or corticosteroid use (27.7% hydroxychloroquine, 26.5% biologics, 27.7% conventional DMARDs, 12.7% corticosteroids, 4.7% small molecules, 0.9% other DMARDs). Before the 1^st vaccine dose, 204 medications (15.7%) were modified; of these, 19% were taken earlier than scheduled, and 81% were delayed/skipped. At 2^nd dose, out of 899 individual medication reports, 251 medications (27.9%) were modified. Of these, 105 medications (41.8%) were delayed/skipped between the 1^st and 2^nd dose, 41 (16.3%) were taken earlier than scheduled and 105 (41.8%) were delayed/skipped after the 2^nd vaccine dose. Biologics, typically anti-TNF inhibitors, and conventional DMARDs, typically methotrexate, accounted for most of the medications modified before or after the vaccine doses (Table 1). Patients modified their own medications >50% of the time before the 1^st vaccine dose, and opted to take medication early >70% of the time before the 2^nd vaccine dose (Table 2). Over half of the medications that were delayed/skipped after the 2^nd vaccine were recommended by a rheumatologist (Table 2).

Conclusion: Up to 28% of immunomodulatory or immunosuppressive medications were modified around the time of COVID-19 vaccination, and patients were responsible for up to 73% of modifications. The wide variety of medication modification provides insight into patient behavior and underscores the need for increased usage of evidence-based guidelines to inform patient and physician guidelines. Future studies will assess the implications of these medication modifications on SRD activity and flares post-vaccination.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/immunomodulatory-and-immunosuppressive-medication-modification-among-rheumatology-patients-at-the-time-of-covid-19-vaccination/