Vaccine Third Dose Guidance
Updated Oct 22, 2021
Arthritis & Rheumatism Associates (ARA) is aware that the CDC has recently recommended an extra dose of all 3 vaccines for or a broader group of patients other than those who are immunocompromised. Past recommendations for this select group of patients were issued in August 2021 (see below). Eligibility now for the booster dose has been expanded, depending on a person’s age, underlying medical condition, workplace, and living situation.
All patients ≥ 65 years are eligible to receive the Moderna or Pfizer booster dose as soon as 6 months after completing the original vaccine series. Those who received the J&J vaccination can now receive their booster dose as soon as 2 months after the original dose.
Select patients 18-64 years are eligible to receive a booster dose also. CDC recommends those with underlying medical conditions, at increased risk of exposure and transmission at work, or who live in long-term care facilities should consider getting a booster dose.
FDA has authorized a “mix-and-match” approach for the booster dose. CDC has announced that eligible patients may select which booster dose to receive. It can be different from the original one they received.
In August 2021, the CDC recommended that moderate to severely immunocompromised patients receive an extra COVID vaccine dose (either Moderna or Pfizer) no sooner than 28 days after completing the original vaccine series.
The Moderna COVID vaccine is available for eligible patients (see above) at select ARA locations (Frederick, Rockville, Olney, Wheaton, Chevy Chase, and Fairfax). ARA can now give you the Moderna vaccine if you have previously received the J&J vaccine at least 2 months ago. 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 original Pfizer vaccine series, you are also eligible to mix-and-match your third dose and receive the Moderna vaccine.
At this time, it is not required to get a letter for clearance to get an extra vaccine dose. 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 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:
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Xeljanz (tofacitinib) |
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Rinvoq (upadacitinib) |
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Olumiant (baricitinib) |
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Cellcept (mycophenolate) |
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Cyclosporine (oral) |
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Tacrolimus (oral) |
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Lupkynis (voclosporin) |
If you take methotrexate and your rheumatologic disease is doing well:
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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:
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Orencia (abatacept) |
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Rituxan (rituximab) |
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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):
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Actemra |
Guselkumab (Tremfya) |
Sarilumab (Kevzara) |
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Adalimumab (Humira) |
Humira |
Secukinumab (Cosentyx) |
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Anakinra (Kineret) |
hydrocortisone |
Simponi |
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Arava (leflunomide) |
Hydroxychloroquine (Plaquenil) |
Simponi Aria |
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Azathioprine (Imuran) |
Ilaris |
Skyrizi |
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Belimumab (Benlysta) |
Imuran |
Stelara |
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Benlysta |
Infliximab (Remicade, Inflectra, Renflexis) |
Sulfasalazine |
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Canakinumab (Ilaris) |
Ixekizumab (Taltz) |
Taltz |
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Certolizumab (Cimzia) |
Kevzara |
Tocilizumab (Actemra) |
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Cimzia |
Kineret |
Tremfya |
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Cosentyx |
Leflunomide |
Ustekinumab (Stelara |
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Cyclophosphamide oral only (Cytoxan) |
Prednisone |
Zoledronic acid (Reclast) |
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Cytoxan (oral only) |
Prolia |
|
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Denosumab (Prolia) |
Reclast |
|
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Enbrel |
Remicade |
|
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Etanercept (Enbrel) |
Rizankizumab (Skyrizi) |
|
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Evenity |
Romosozumab (Evenity) |
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|
|
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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:
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Arava (leflunomide) |
Methotrexate (Otrexup, Rasuvo, Rheumatrex) |
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Azathioprine (Imuran) |
Mycophenolate (Cellcept) |
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Apremilast (Otezla) |
Olumiant (baricitinib) |
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Belimumab (Benlysta) |
Orencia (abatacept) |
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Benlysta |
Otezla |
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Cellcept |
Rinvoq (upadacitinib) |
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Cyclophosphamide (Cytoxan) |
Rituxan (rituximab) |
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Cyclosporine |
Sulfasalazane |
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Cytoxan |
Tacrolimus (oral) |
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Imuran |
Voclosporin (Lupkynis) |
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Leflunomide |
Xeljanz (tofacitinib) |
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Lupkynis |
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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:
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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.