Dr. Naval Mendiratta
Rheumatology
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hi doctor,
I am presently taking one pen of Humira every two weeks and 10 mg of Leflunomide daily. I started to take Humira a couple of years back, and I have not experienced any flares till now. I am about to get the Pfizer COVID-19 vaccine tomorrow. However, I have been reading reports from the media that the vaccine's efficacy has not been tested on people under medication for autoimmune disorders, and it may be ineffective. I have also read that people with autoimmune disorders should stop taking their medication for a week to make the vaccine work and create antibodies. I have been reading new articles that people with an autoimmune disorder such as rheumatoid arthritis will not develop any antibodies due to the arthritis medication, which depresses the immune system. However, it has been suggested that people taking Humira like me will be able to get an antibody response by the vaccine if they do not take the Humira and Leflunomide for a week. I am providing you a copy of my bloodwork which I did last week, for your reference.
Hi,
Welcome to icliniq.com.
I have gone through your question and the blood reports (attachment removed to protect the patient's identity). The blood reports look pretty in control. CRP (C-reactive protein) is a marker that should be checked before vaccination in autoimmune patients and that is within the normal range for you. Secondly, please go ahead with the vaccination, as getting through the pandemic is one of the main goals right now. And Pfizer has shown good efficacy against certain strains, so that would be a worthwhile choice. As for the medication adjustment, it is only Humira (Adalimumab)we need to adjust. The ideal rule is a gap of two weeks between Humira and the vaccine. So you will be skipping one dose of Humira. I am not sure when you last took the Humira as your vaccine is scheduled for tomorrow. So if there is a two-week gap, it gives sufficient time to generate the antibodies that are needed. As for Leflunomide, I tell the patients to skip on the day and next day of the vaccine. Leflunomide does not alter the immune response of the vaccine. It is mainly halted for two days to ensure that the drug does not complicate it if you react to the vaccine. So I guess just time your Humira accordingly and go with the immunization shot. The efficacy may not be 90 percent as in people with no autoimmune disease, but 70 percent will be generated, which is sufficient to protect you against this deadly virus. I hope the information was helpful. Do revert for any queries.
Thank you.
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Rheumatology
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