Vaccine Guidance

The physicians of Arise Infusion are aware that the CDC and FDA has recommended COVID-19 booster shots for immunocompromised patients. Based on recommendations from the CDC and FDA, patients who have an autoimmune condition and are on prednisone or immune modulating medication are eligible for a third dose of either the Pfizer or Moderna vaccine. At present, it is recommended that the third dose be the same type as what was originally given. If you received the J&J vaccine, it is not yet recommended for you to get a second dose of the vaccine. Recommendations should be coming soon.

Patients who are on medication for an autoimmune condition and have received the Moderna vaccine with the second dose being more than 28 days ago are eligible to get a third dose of Moderna at select Arise locations (Frederick, Rockville, Olney, Wheaton, Chevy Chase). Arise can only give you the booster if you have previously received the Moderna vaccine. If you would like to make an appointment at one of these locations, please request one through your patient portal. We do not recommend calling to make an appointment. If you received the Pfizer vaccine, you should contact your pharmacy to obtain an appointment for a third dose, or for vaccine clinics nationwide visit www.vaccine.gov, text your zip to 438829, or call (800) 232-0233.

At this time, it is not required to get a letter for clearance to get the third vaccine. If you are asked for a letter, one can be provided to you through your patient portal.

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)
Lupkynis


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.