Abstract
Impressive efforts have been made by researchers worldwide in the development of target vaccines against the novel severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and in improving the management of immunomodulating agents. Currently, different vaccine formulations, such as viral vector, mRNA, and protein-based, almost all directed toward the spike protein that includes the domain for receptor binding, have been approved. Although data are not conclusive, patients affected by autoimmune rheumatic diseases (ARDs) seem to have a slightly higher disease prevalence, risk of hospitalization, and death from coronavirus disease-2019 (COVID-19) than the general population. Therefore, ARD patients, under immunosuppressive agents, have been included among the priority target groups for vaccine administration. However, specific cautions are needed to optimize vaccine safety and effectiveness in these patients, such as modification in some of the ongoing immunosuppressive therapies and the preferential use of mRNA other than vector-based vaccines. Immunomodulating agents can be a therapeutic opportunity for the management of COVID-19 patients; however, their clinical impact depends on how they are handled. To place in therapy immunomodulating agents in the correct window of opportunity throughout the identification of surrogate markers of disease progression and host immune response is mandatory to optimize patient’s outcome.
Highlights
During the first wave of the coronavirus disease-2019 (COVID-19) pandemic, we discussed the complex relationship between autoimmunity and the novel severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) [1]
We concluded that anti-cytokine therapy, in particular the anti-IL-6 tocilizumab (TCZ) and the Janus kinase (JAK) inhibitor baricitinib, seemed to be the most promising drugs provided that their use was tailored to both timing of symptom onset and COVID-19 severity
The aim of this review is to identify in the selected category of autoimmune rheumatic diseases (ARDs) patients the main controversial issues in terms of safety, efficacy, and effectiveness of SARS-CoV-2 vaccines and how to place vaccination in the context of the therapy with immunosuppressive agents, as well as to clinical parameters of disease severity and host immune response
Summary
During the first wave of the coronavirus disease-2019 (COVID-19) pandemic, we discussed the complex relationship between autoimmunity and the novel severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) [1]. The aim of this review is to identify in the selected category of ARD patients the main controversial issues in terms of safety, efficacy, and effectiveness of SARS-CoV-2 vaccines and how to place vaccination in the context of the therapy with immunosuppressive agents, as well as to clinical parameters of disease severity and host immune response. It should be taken into account that GCs are not exempt from known severe side effects; in particular, high-dose GC can inhibit immune response, reduce pathogen clearance, and increase viral replication; their use in mild/moderate patients not requiring oxygen supplementation and in the first stage of disease is contraindicated; low-dose (up to 6 mg of DEX or equivalent) and short-term GCs (up to 6 days) are recommended. SEVERE ACUTE RESPIRATORY SYNDROME CORONAVIRUS-2 VACCINE IN RHEUMATIC AUTOIMMUNE DISEASES
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