Background/Purpose: Patients with autoimmune inflammatory rheumatic diseases (AIIRD) are at increased risk of infections due to both immune system dysfunction and the use of immunosuppressive therapies. Vaccination is a key preventive strategy to reduce infection-related morbidity and mortality in this population. This study aimed to develop evidence-based vaccination recommendations for adults with AIIRD in Saudi Arabia, based on international guidelines (ACR, EULAR, CDC, WHO), current literature on vaccine safety and efficacy, and expert consensus. The recommendations address vaccine timing, safety, and immunogenicity, covering both live and non-live vaccines, and emphasize a personalized approach that balances optimal protection with the risk of disease flares and treatment considerations.

Methods: A Delphi consensus method was used to develop expert-based vaccination recommendations for patients with AIIRD. A multidisciplinary panel comprising rheumatology, infectious disease, and immunology specialists participated in a structured, three-round process. This included an initial open-ended survey, followed by quantitative rating of statements on a 10–100 scale, with ≥70% agreement required to establish consensus. Statements not reaching consensus were revised and re-evaluated. Data collection was conducted via Word documents and Google Sheets, and both online and in-person meetings supported iterative discussion and finalization of recommendations.

Results: A review of current literature and consensus guidelines revealed that inactivated influenza vaccination is safe and generally effective in patients with AIIRD, even while receiving immunosuppressive therapy. Patients on methotrexate demonstrated improved vaccine immunogenicity when the drug was withheld for 1–2 weeks post-vaccination, without a significant increase in disease flares. For those on rituximab, delaying therapy for at least 2 weeks after vaccination may enhance immune response if disease activity permits. Vaccination is strongly recommended for patients on prednisone ≤10 mg/day and conditionally recommended at higher doses due to potentially reduced efficacy. Use of TNF inhibitors and JAK inhibitors did not significantly impair immune responses, supporting vaccine administration without treatment interruption. Despite modest reductions in immunogenicity in certain subgroups, partial protection remains clinically beneficial, reinforcing the importance of annual influenza vaccination in our population.

Conclusion: Vaccination plays a vital role in reducing infection-related risks in patients with AIIRD. We present comprehensive recommendations aligned with international guidelines, highlighting the preference for non-live vaccines, the contraindication of live vaccines in immunosuppressed patients, and the importance of individualized vaccination plans. It underscores the need to enhance physician awareness and patient education to improve vaccine uptake and calls for future research to optimize vaccine responses and expand immunization strategies in Saudi population.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/saudi-society-for-rheumatology-consensus-recommendation-on-vaccination-strategies-in-adults-saudi-with-autoimmune-rheumatic-disorders/