Updated COVID Vaccine Booster Guidance
Last updated September 6, 2022
The CDC recommends age-eligible individuals receive the updated Moderna or Pfizer COVID vaccine booster to improve protection against a possible surge in COVID cases starting this fall. The updated boosters are bivalent vaccines modified to enhance immunity against the Omicron BA.4/BA.5 subvariants as well as more broadly restore waning protection against the original strain.
The Moderna bivalent is recommended for individuals ≥ 18 years and the Pfizer bivalent for those ≥ 12 years who have completed the primary COVID vaccine series. The bivalents are administered as a single dose ≥ 2 months after the primary series or booster vaccine of any manufacturer, regardless of the number of prior boosters received.
The FDA has authorized in the past a “mix-and-match” approach for the booster doses so that one can choose either a booster of the same vaccine as the primary series or a booster of the other available mRNA vaccine. Arthritis and Rheumatism Associates providers support the American College of Rheumatology recommendation that patients who received the J&J vaccine choose a booster dose of an mRNA-based vaccine (either Moderna or Pfizer).
Unvaccinated individuals remain eligible to receive either the original Moderna or Pfizer monovalent COVID vaccine as part of their primary series.
Both Moderna bivalent and monovalent COVID vaccines are available for eligible ARA patients at select locations (Frederick, Rockville, Olney, Wheaton, Chevy Chase, and Fairfax). To schedule an appointment, please request one through the patient portal rather than call the office.
Medication & COVID-19 Vaccines
For our patients who have not yet had an initial vaccination, the physicians of ARA 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 supplemental 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:
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:
|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 vaccine doses see the different list):
|Actemra||Guselkumab (Tremfya)||Sarilumab (Kevzara)|
|Adalimumab (Humira)||Humira||Secukinumab (Cosentyx)|
|Arava (leflunomide)||Hydroxychloroquine (Plaquenil)||Simponi Aria|
|Benlysta||Infliximab (Remicade, Inflectra, Renflexis)||Sulfasalazine|
|Canakinumab (Ilaris)||Ixekizumab (Taltz)||Taltz|
|Certolizumab (Cimzia)||Kevzara||Tocilizumab (Actemra)|
|Cyclophosphamide oral only (Cytoxan)||Prednisone||Zoledronic acid (Reclast)|
|Cytoxan (oral only)||Prolia|
|Etanercept (Enbrel)||Rizankizumab (Skyrizi)|
Holding medications around the time of 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 supplemental vaccination, then restart taking them:
|Arava (leflunomide)||Methotrexate (Otrexup, Rasuvo, Rheumatrex)|
|Azathioprine (Imuran)||Mycophenolate (Cellcept)|
|Apremilast (Otezla)||Olumiant (baricitinib)|
|Belimumab (Benlysta)||Orencia (abatacept)|
|Cyclophosphamide (Cytoxan)||Rituxan (rituximab)|
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 dose of mRNA vaccine:
|Actemra||Cimzia||Ilaris||Olumiant (baricitinib)||Simponi Aria||Xeljanz (tofacitinib)|
|Adalimumab (Humira)||Cosentyx||Imuran||Orencia (abatacept)||Skyrizi|
|Anakinra (Kineret)||Cyclophosphamide (Cytoxan)||Infliximab (Remicade, Inflectra, Renflexis, etc.)||Prednisone and methylprednisolone||Stelara|
|Arava (leflunomide)||cyclosporine||Ixekizumab (Taltz)||Remicade||Sulfasalazine|
|Azathioprine (Imuran)||Cytoxan||Kevzara||Rinvoq (upadacitinib)||Tacrolimus (oral)|
|Belimumab (Benlysta)||Enbrel||Kineret||Rituxan (rituximab)||Taltz|
|Benlysta||Etanercept (Enbrel)||Leflunomide||Rizankizumab (Skyrizi)||Tocilizumab (Actemra)|
|Canakinumab (Ilaris)||Guselkumab (Tremfya)||Lupkynis||Sarilumab (Kevzara)||Tremfya|
|Cellcept||Humira||Methotrexate (Otrexup, Rasuvo, Rheumatrex)||Secukinumab (Cosentyx)||Ustekinumab (Stelara)|
|Certolizumab (Cimzia)||Hydrocortisone (oral)||Mycophenolate (Cellcept)||Simponi||Voclosporin (Lupkynis)|
Reference link: American College of Rheumatology COVID-19 Vaccine Clinical Guidance Summary for Patients with Rheumatic and Musculoskeletal Diseases.