Vaccine Booster Guidance

Updated August 31, 2021

Arthritis & Rheumatism Associates (ARA) is aware that the CDC and FDA has recommended COVID-19 booster shots for immunocompromised patients. Based on recommendations from the CDC and FDA, patients who have an autoimmune condition and are on prednisone or immune modulating medication are eligible for a third dose of either the Pfizer or Moderna vaccine.  At present, it is recommended that the third dose be the same type as what was originally given. If you received the J&J vaccine, it is not yet recommended for you to get a second dose of the vaccine. Recommendations should be coming soon.

Patients who are on medication for an autoimmune condition and have received the Moderna vaccine with the second dose being more than 28 days ago are eligible to get a third dose of Moderna at select ARA locations (Frederick, Rockville, Olney, Wheaton, Chevy Chase). ARA can only give you the booster if you have previously received the Moderna vaccine. If you would like to make an appointment at one of these locations, please request one through your patient portal. We do not recommend calling to make an appointment.  If you received the Pfizer vaccine, you should contact your pharmacy to obtain an appointment for a third dose, or check the ARA website for other local vaccine clinics.

At this time, it is not required to get a letter for clearance to get the third vaccine. If you are asked for a letter, one can be provided to you through your patient portal.

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 “booster” 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:

Xeljanz (tofacitinib)

Rinvoq (upadacitinib)

Olumiant (baricitinib)

Cellcept (mycophenolate)

Cyclosporine (oral)

Tacrolimus (oral)

Lupkynis (voclosporin)

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: 

Orencia (abatacept)

Rituxan (rituximab)

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 “booster” vaccine doses see the different list):

 

Actemra	Guselkumab (Tremfya)	Sarilumab (Kevzara)
Adalimumab (Humira)	Humira	Secukinumab (Cosentyx)
Anakinra (Kineret)	hydrocortisone	Simponi
Arava (leflunomide)	Hydroxychloroquine (Plaquenil)	Simponi Aria
Azathioprine (Imuran)	Ilaris	Skyrizi
Belimumab (Benlysta)	Imuran	Stelara
Benlysta	Infliximab (Remicade, Inflectra, Renflexis)	Sulfasalazine
Canakinumab (Ilaris)	Ixekizumab (Taltz)	Taltz
Certolizumab (Cimzia)	Kevzara	Tocilizumab (Actemra)
Cimzia	Kineret	Tremfya
Cosentyx	Leflunomide	Ustekinumab (Stelara
Cyclophosphamide oral only (Cytoxan)	Prednisone	Zoledronic acid (Reclast)
Cytoxan (oral only)	Prolia
Denosumab (Prolia)	Reclast
Enbrel	Remicade
Etanercept (Enbrel)	Rizankizumab (Skyrizi)
Evenity	Romosozumab (Evenity)

Holding medications around the time of “booster” or 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 booster vaccination, then restart taking them:

 

Arava (leflunomide)	Methotrexate (Otrexup, Rasuvo, Rheumatrex)
Azathioprine (Imuran)	Mycophenolate (Cellcept)
Apremilast (Otezla)	Olumiant (baricitinib)
Belimumab (Benlysta)	Orencia (abatacept)
Benlysta	Otezla
Cellcept	Rinvoq (upadacitinib)
Cyclophosphamide (Cytoxan)	Rituxan (rituximab)
Cyclosporine	Sulfasalazane
Cytoxan	Tacrolimus (oral)
Imuran	Voclosporin (Lupkynis)
Leflunomide	Xeljanz (tofacitinib)
Lupkynis

 

Immune Modulating Medications

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 “booster” 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.