. 2021 May 24;73(7):1093–1107. doi: 10.1002/art.41734

Table 4.

Guidance related to the timing of COVID‐19 vaccination in relation to use of immunomodulatory therapies in RMD patients*

Medication(s)	COVID‐19 vaccine administration timing considerations	Level of task force consensus
Hydroxychloroquine; sulfasalazine; leflunomide; apremilast; IVIG	Do not delay or adjust vaccine administration timing.	Strong
Methotrexate; mycophenolate mofetil; azathioprine; cyclophosphamide (IV or oral); TNFi; IL‐6R; IL‐1Ra; IL‐17; IL‐12/IL‐23; IL‐23; belimumab; JAK inhibitors; abatacept (IV or SC); oral calcineurin inhibitors; GCs (prednisone‐equivalent dose <20 mg/day) †	Do not delay or adjust vaccine administration timing.	Moderate
Rituximab	Assuming that a patient’s COVID‐19 risk is low or able to be mitigated by preventive health measures (e.g., self‐isolation), schedule vaccination so that the vaccine series is initiated ~4 weeks prior to next scheduled rituximab cycle.	Moderate

Medication(s)

COVID‐19 vaccine administration

timing considerations

Level of task force

consensus

Hydroxychloroquine; sulfasalazine; leflunomide; apremilast; IVIG

Do not delay or adjust vaccine administration timing.

Strong

Methotrexate; mycophenolate mofetil; azathioprine; cyclophosphamide (IV or oral); TNFi; IL‐6R; IL‐1Ra; IL‐17; IL‐12/IL‐23; IL‐23; belimumab; JAK inhibitors; abatacept (IV or SC); oral calcineurin inhibitors; GCs (prednisone‐equivalent dose <20 mg/day) †

Do not delay or adjust vaccine administration timing.

Moderate

Rituximab

Assuming that a patient’s COVID‐19 risk is low or able to be mitigated by preventive health measures (e.g., self‐isolation), schedule vaccination so that the vaccine series is initiated ~4 weeks prior to next scheduled rituximab cycle.

Moderate

COVID‐19 = coronavirus disease 2019; RMD = rheumatic and musculoskeletal disease; IVIG = intravenous immunoglobulin; TNFi = tumor necrosis factor inhibitor; SC = subcutaneous.

^{^†}

Examples of cytokine and kinase inhibitors include the following: for interleukin‐6 receptor (IL‐6R), sarilumab and tocilizumab; for IL‐1 receptor antagonist (IL‐1Ra), anakinra and canakinumab; for IL‐17, ixekizumab and secukinumab; for IL‐12/IL‐23, ustekinumab; for IL‐23, guselkumab and rizankizumab; for JAK inhibitors, baricitinib, tofacitinib, and upadacitinib. Consensus was not reached for patients receiving glucocorticoids (GCs) at prednisone‐equivalent doses of ≥20 mg/day.

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