Vaccine Guidance

Clinical Team

Last updated September 6, 2022  

The CDC recommends age-eligible individuals receive the updated Moderna or Pfizer COVID vaccine booster to improve protection against a possible surge in COVID cases starting this fall.  The updated boosters are bivalent vaccines modified to enhance immunity against the Omicron BA.4/BA.5 subvariants as well as more broadly restore waning protection against the original strain. 

The Moderna bivalent is recommended for individuals ≥ 18 years and the Pfizer bivalent for those ≥ 12 years who have completed the primary COVID vaccine series. The bivalents are administered as a single dose ≥ 2 months after the primary series or booster vaccine of any manufacturer, regardless of the number of prior boosters received.  

The FDA has authorized in the past a “mix-and-match” approach for the booster doses so that one can choose either a booster of the same vaccine as the primary series or a booster of the other available mRNA vaccine. Arise providers support the American College of Rheumatology recommendation that patients who received the J&J vaccine choose a booster dose of an mRNA-based vaccine (either Moderna or Pfizer).  

Unvaccinated individuals remain eligible to receive either the original Moderna or Pfizer monovalent COVID vaccine as part of their primary series.   

Both Moderna bivalent and monovalent COVID vaccines are available for eligible Arise patients at select locations (Frederick, Rockville, Olney, Wheaton, Chevy Chase, and Fairfax). To schedule an appointment, please request one through the patient portal rather than call the office.

Medication & COVID-19 Vaccines

For our patients who have not yet had an initial vaccination, the physicians of Arise encourage our patients to obtain any of the mRNA COVID-19 vaccines (Pfizer or Moderna), which are preferred at this time based on the American College of Rheumatology guidance, partly due to the availability of “booster” doses for the mRNA vaccines.

We support the guidance from the American College of Rheumatology regarding how to take various medications around the time of COVID-19 vaccinations:

If you take ibuprofen, naproxen, other NSAIDs, or Tylenol, and your rheumatologic disease is doing well, do not take them for 24 hours prior to vaccination (no restrictions on use post-vaccination).

If you take any of the following medications, and your rheumatologic disease is doing well, do not take this medication for 1 week after each dose of the COVID-19 vaccine:

Xeljanz (tofacitinib)
Rinvoq (upadacitinib)
Olumiant (baricitinib)
Cellcept (mycophenolate)
Cyclosporine (oral)
Tacrolimus (oral)
Lupkynis (voclosporin)

If you take methotrexate and your rheumatologic disease is doing well:

Do not take methotrexate for 1 week after each of the mRNA vaccine doses (Pfizer, Moderna)

Do not take methotrexate for 2 weeks after single-dose vaccine (Johnson & Johnson)

If you take the following medications, contact ARA when you are nearing the time of your COVID-19 vaccination to plan scheduling the doses: 

Orencia (abatacept)
Rituxan (rituximab)
Cyclophosphamide intravenous only (Cytoxan)

If you take the following medications, you do not have to change your medication dosing schedule around the time of your initial COVID-19 vaccination (for advice about supplemental “booster” vaccine doses see the different list):

Actemra Guselkumab (Tremfya) Sarilumab (Kevzara)
Adalimumab (Humira) Humira
Secukinumab (Cosentyx)
Anakinra (Kineret) hydrocortisone Simponi
Arava (leflunomide) Hydroxychloroquine (Plaquenil) Simponi Aria
Azathioprine (Imuran) Ilaris Skyrizi
Belimumab (Benlysta) Imuran Stelara
Benlysta Infliximab (Remicade, Inflectra, Renflexis) Sulfasalazine
Canakinumab (Ilaris) Ixekizumab (Taltz) Taltz
Certolizumab (Cimzia) Kevzara Tocilizumab (Actemra)
Cimzia Kineret Tremfya
Cosentyx Leflunomide Ustekinumab (Stelara
Cyclophosphamide oral only (Cytoxan) Prednisone
Zoledronic acid (Reclast)
Cytoxan (oral only) Prolia
Denosumab (Prolia) Reclast
Enbrel Remicade
Etanercept (Enbrel) Rizankizumab (Skyrizi)
Evenity Romosozumab (Evenity)

Holding medications around the time of “booster” or supplemental dose of vaccine. If you are taking one of these medications or were taking them when you received your initial mRNA vaccination. If your rheumatologic disease is doing well, do not take any of the following medications for 1-2 weeks after booster vaccination, then restart taking them:

Arava (leflunomide) Methotrexate (Otrexup, Rasuvo, Rheumatrex)
Azathioprine (Imuran) Mycophenolate (Cellcept)
Apremilast (Otezla) Olumiant (baricitinib)
Belimumab (Benlysta) Orencia (abatacept)
Benlysta Otezla
Cellcept Rinvoq (upadacitinib)
Cyclophosphamide (Cytoxan) Rituxan (rituximab)
Cyclosporine Sulfasalazane
Cytoxan Tacrolimus (oral)
Imuran Voclosporin (Lupkynis)
Leflunomide Xeljanz (tofacitinib)

If you are taking one of these medications (or were taking them when you received your initial mRNA vaccination) then you should obtain a supplemental “booster” dose of mRNA vaccine:

Immune Modulating Medications

Actemra Ilaris Skyrizi
Adalimumab (Humira) Imuran Stelara
Anakinra (Kineret) Infliximab (Remicade, Inflectra, Renflexis, etc.) Sulfasalazine
Arava (leflunomide) Ixekizumab (Taltz) Tacrolimus (oral)
Azathioprine (Imuran) Kevzara Taltz
Belimumab (Benlysta) Kineret Tocilizumab (Actemra)
Benlysta Leflunomide Tremfya
Canakinumab (Ilaris) Lupkynis Ustekinumab (Stelara)
Cellcept Methotrexate (Otrexup, Rasuvo, Rheumatrex) Voclosporin (Lupkynis)
Certolizumab (Cimzia) Mycophenolate (Cellcept) Xeljanz (tofacitinib)
Cimzia Orencia (abatacept) Xeljanz (tofacitinib)
Cosentyx Prednisone and methylprednisolone
Cyclophosphamide (Cytoxan) Remicade
cyclosporine Rinvoq (upadacitinib)
Cytoxan Rituxan (rituximab)
Enbrel Rizankizumab (Skyrizi)
Etanercept (Enbrel) Sarilumab (Kevzara)
Guselkumab (Tremfya) Secukinumab (Cosentyx)
Humira Simponi
Hydrocortisone (oral) Simponi Aria

Reference link:
American College of Rheumatology COVID-19 Vaccine Clinical Guidance Summary for Patients with Rheumatic and Musculoskeletal Diseases.