By Katherine Tam

Some of our neighbors living with autoimmune conditions have recently asked us whether it’s safe for them to get their COVID-19 vaccine. 

In particular, our neighbors have concerns that due to the nature of the drugs being used to treat autoimmune conditions, those treatments’ effects may conflict with the effectiveness of the Pfizer, Moderna or Johnson & Johnson vaccines.  

One concern we’ve heard repeatedly is fear of an adverse reaction when they receive a COVID-19 vaccine.

To help answer their questions, we turned to Dr. Mark Horowitz, a family doctor in Lower Manhattan and a friend of Epicenter whom we often ask for medical advice.  

First, Horowitz says we need to define what the word “autoimmune” really means:   

  • “Autoimmune diseases are a broad category of diseases that have in common situations where the body does not recognize its own organs, and therefore attacks in some immunologic way its own organs,” Horowitz explains.  “The most common autoimmune conditions that you hear of are things like lupus, rheumatoid arthritis, various forms of thyroid disease, certain forms of diabetes, psoriasis and certain other skin conditions.” 
  • Horowitz says he’s also serving as a medical adviser to CUNY, where he’s having to decide on students’ requests for exemptions from vaccination.  “I’m seeing the word ‘autoimmune’ pop up a lot,” he says.  “Sometimes they’re used appropriately.  And sometimes, they’re sort of used as a smokescreen for people who would prefer not to get the vaccine.”  

Second, Horowitz says it’s important that people with co-existing medical conditions understand they are at risk for COVID-19 complications.  However, those living with autoimmune conditions should talk to their doctor about the timing of their vaccinations:

  • “Where we get into some issues is in people who are on certain treatments for these autoimmune diseases,” Horowitz says. 
  • He explains there are three different types of medications that are used for some of these autoimmune conditions.  They include: 1) steroids, “with prednisone being the most common”; 2) medications that he says have traditionally been used as chemotherapy agents in patients with cancer, but also have benefit in certain autoimmune diseases, with the most common of those medications being methotrexate; and 3) a class of medications called biologics that are increasingly being used in autoimmune diseases, with Humira and Rituxan among the most common of these medications.
  • “Where these medicines create a dilemma for the patient with autoimmune diseases is that they may make the vaccine less effective,” Horowitz says.  “So if I give a vaccine to someone who’s on one of these medications, they may make less antibodies against the coronavirus, and therefore, they may be incompletely protected.”  
  • “In no case is it dangerous for a patient on one of these medications to get the coronavirus vaccine,” Horowitz says.  “But there is a discussion that should take place with the patient’s doctor–often a gastroenterologist or rheumatologist or an endocrinologist or in some cases a primary care doctor–about the timing of the vaccination.”
  • In particular, Horowitz advises that “if someone is on methotrexate, there’s a discussion that should take place with the person’s doctor about the vaccine.” 

Finally, Horowitz says autoimmune conditions actually make it “more imperative” that the patient gets their vaccine:

  • “There are plenty of people who are on these medications (treating autoimmune conditions) who are taking the vaccine and becoming immune to coronavirus,” Horowitz emphasizes.  “Without question, people who are on these medications should have a third dose or a booster dose, now or soon.”

For more information, Horowitz also recommends reading this article from the University of Chicago Medical Center.

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