Canadian Rheumatology Association Recommendation for the Use of COVID-19 Vaccination for Patients With Autoimmune Rheumatic Diseases

Glen S Hazlewood; Jordi Pardo Pardo; Cheryl Barnabe; Orit Schieir; Claire E H Barber; Sasha Bernatsky; Ines Colmegna; Carol Hitchon; Mark Loeb; Dominik Mertz; Laurie Proulx; Dawn P Richards; Rosie Scuccimarri; Peter Tugwell; Holger J Schünemann; Reza D Mirza; Alan L Zhou; Roko P A Nikolic; Megan Thomas; Helena Chase; Maede Ejaredar; Robby Nieuwlaat

doi:10.3899/jrheum.210288

Canadian Rheumatology Association Recommendation for the Use of COVID-19 Vaccination for Patients With Autoimmune Rheumatic Diseases

J Rheumatol. 2021 Aug;48(8):1330-1339. doi: 10.3899/jrheum.210288. Epub 2021 May 15.

Authors

Glen S Hazlewood¹, Jordi Pardo Pardo², Cheryl Barnabe³, Orit Schieir⁴, Claire E H Barber³, Sasha Bernatsky⁵, Ines Colmegna⁶, Carol Hitchon⁷, Mark Loeb⁸, Dominik Mertz⁸, Laurie Proulx⁹, Dawn P Richards⁹, Rosie Scuccimarri¹⁰, Peter Tugwell¹¹, Holger J Schünemann⁸, Reza D Mirza¹², Alan L Zhou¹¹, Roko P A Nikolic¹³, Megan Thomas¹⁴, Helena Chase¹⁵, Maede Ejaredar¹⁴, Robby Nieuwlaat¹⁶

Affiliations

¹ G.S. Hazlewood, MD, PhD, Associate Professor of Medicine, C. Barnabe, MD, MSc, Associate Professor of Medicine, C.E. Barber, MD, PhD, Assistant Professor of Medicine, Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, and Arthritis Research Canada, Richmond, British Columbia; gshazlew@ucalgary.ca.
² J.P. Pardo, LDO, Managing Editor, Centre for Global Health, University of Ottawa, Ottawa, Ontario.
³ G.S. Hazlewood, MD, PhD, Associate Professor of Medicine, C. Barnabe, MD, MSc, Associate Professor of Medicine, C.E. Barber, MD, PhD, Assistant Professor of Medicine, Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, and Arthritis Research Canada, Richmond, British Columbia.
⁴ O. Schieir, PhD, Canadian Early Arthritis Cohort Study, Toronto, Ontario.
⁵ S. Bernatsky, MD, PhD, Professor of Medicine, Research Institute of the McGill University Health Centre (RI-MUHC), Montreal, Quebec.
⁶ I. Colmegna, MD, Associate Professor of Medicine, Division of Rheumatology, Department of Medicine, McGill University, Montreal, Quebec.
⁷ C. Hitchon, MD, MSc, Associate Professor of Medicine, Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba.
⁸ M. Loeb, MD, MSc, Professor, D. Mertz, MD, MSc, Associate Professor of Medicine, H.J. Schünemann, MD, MSc, PhD, Professor of Medicine and Clinical Epidemiology, Departments of Medicine and Health Research Methods, Evidence, and Impact, McMaster GRADE Centers, Hamilton.
⁹ L. Proulx, B.Com, D.P. Richards, PhD, Canadian Arthritis Patient Alliance, Toronto, Ontario.
¹⁰ R. Scuccimarri, MD, Associate Professor of Pediatrics, Division of Pediatric Rheumatology, Department of Pediatrics, McGill University, Montreal, Quebec.
¹¹ P. Tugwell, MD, Professor of Medicine, A.L. Zhou, MD, Department of Medicine, University of Ottawa, Ottawa, Ontario.
¹² R.D. Mirza, MD, Department of Medicine, University of Toronto, Toronto, Ontario.
¹³ R.P. Nikolic, BSc, Cumming School of Medicine, University of Calgary, Calgary, Alberta.
¹⁴ M. Thomas, BHSc, M. Ejaredar, PhD, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta.
¹⁵ H. Chase, University of Ottawa, Ottawa, Ontario.
¹⁶ R. Nieuwlaat, MSc, PhD, Associate Professor, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.

PMID: 33993119
DOI: 10.3899/jrheum.210288

Abstract

Objective: To develop guidance on the use of coronavirus disease 2019 (COVID-19) vaccines in patients with autoimmune rheumatic diseases (ARD).

Methods: The Canadian Rheumatology Association (CRA) formed a multidisciplinary panel including rheumatologists, researchers, methodologists, vaccine experts, and patients. The panel used the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach. Outcomes were prioritized according to their importance for patients and clinicians. Evidence from the COVID-19 clinical trials was summarized. Indirect evidence for non-COVID-19 vaccines in ARD was also considered. The GRADE evidence-to-decision (EtD) framework was used to develop a recommendation for the use of the 4 COVID-19 vaccines approved in Canada as of March 25, 2021 (BNT162b2, mRNA-1273, ChAdOx1, and Ad26.COV2.S), over 4 virtual panel meetings.

Results: The CRA guideline panel suggests using COVID-19 vaccination in persons with ARD. The panel unanimously agreed that for the majority of patients, the potential health benefits of vaccination outweigh the potential harms in people with ARDs. The recommendation was graded as conditional because of low or very low certainty of the evidence on the effects in the population of interest, primarily due to indirectness and imprecise effect estimates. The panel felt strongly that persons with autoimmune rheumatic diseases who meet local eligibility should not be required to take additional steps compared to people without ARDs to obtain their vaccination. Guidance on medications, implementation, monitoring of vaccine uptake, and research priorities are also provided.

Conclusion: This recommendation will be updated over time as new evidence emerges, with the latest recommendation, evidence summaries, and EtD available on the CRA website.

Keywords: COVID-19; GRADE; autoimmune disease; clinical practice guideline; rheumatic diseases; vaccination.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

BNT162 Vaccine
COVID-19 Vaccines / administration & dosage*
COVID-19* / prevention & control
Canada
Humans
Rheumatic Diseases* / complications
Rheumatology*
Vaccination

Substances

COVID-19 Vaccines
BNT162 Vaccine