"In patients with stable disease, it is appropriate to hold mycophenolate to optimize the humoral response (but) patients should discuss this decision with their prescribing provider," Dr. Caoilfhionn Connolly from Johns Hopkins in Baltimore, Maryland, told Reuters Health by email.
As reported in Annals of the Rheumatic Diseases, the researchers studied 195 patients with RMD without prior COVID-19 who were vaccinated against the virus; 24 patients withheld mycophenolate and 171 RMD patients continued on the drug.
Of the 24 patients who withheld the drug, 13 (54%) did so before vaccination, nine (38%) both before and after vaccination and two (8%) after vaccination.
At a median of 32 days post-vaccination, 22 of 24 patients who withheld mycophenolate had detectable antibodies against the receptor-binding domain (anti-RBD) of the SARS-CoV-2 spike protein, compared with 112 of 171 who continued the drug (92% vs. 65%, P=0.01).
Patients who withheld mycophenolate were significantly more likely to have a positive antibody response (odds ratio, 5.8; 95% confidence interval, 1.3 to 25.5; P=0.02).
The median anti-RBD Ig titer in the withholding group was higher than in the group that continued therapy (125 vs. 7 U/L, P=0.004).
In this case series, humoral responses to SARS-CoV-2 vaccination were "more frequent and robust" when mycophenolate was withheld.
"Due to limitations in sample size of this study, we were unable to assess the optimal duration of temporary hold schedule," Dr. Connolly told Reuters Health.
"The American College of Rheumatology (ACR) COVID-19 task force currently recommends holding mycophenolate for 1 week after each vaccine dose for standard vaccine series and for 1-2 weeks after booster dosing in patients in whom disease activity allows; patients should discuss this with their provider," Dr. Connolly added.
Two patients in the cohort who withheld mycophenolate had a flare of their underlying disease requiring treatment in the perivaccination period; these were treated with topical and oral glucocorticoids.
The researchers say "evidence-based, personalized approaches to perivaccination immunosuppression modulation will be key in safely optimizing responses to SARS-CoV-2 vaccination for vulnerable populations."
This study had no commercial funding.
SOURCE: https://bit.ly/3igyHAz Annals of the Rheumatic Diseases, online September 23, 2021.
By Megan Brooks
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