Long shot, but anyone know the answer re: biologics and the covid vaccine?

[kokotg]

My husband is on a biologic (Taltz) for psoriasis and is a high school teacher so should be able to get a covid vaccine in the next couple of months from what I hear. I'm concerned about whether and to what extent his medication will make the vaccine less effective. What I've been able to glean so far is that people on immunosuppressants were excluded from the vaccine trials, so there's no actual data on it at this point, but if it's like other vaccines it will likely be less effective. Fauci says people on immunosuppressants should take it anyway because some protection is better than no protection. Sure. But I would like for him to have as much protection as possible. So what I'm wondering--and what no one will tell him (not his doctor and not anyone at Taltz) is whether it makes sense to stop taking Taltz for a month or two right when he gets the vaccine. He can skip a couple of months without noticing too much difference; it's not a particularly big deal to do it....but he can't get anyone to tell him if it will help. Like...will that give his body time to build up immunity and then that will stick around? Or will restarting the Taltz weaken whatever immunity he has the same as if he'd kept it up all along? Does that make sense? It's also possible he'll need to get titers drawn and maybe have additional boosters, but given that he's in a high exposure job immunity sooner is better. I know the odds someone here will know the answer is small, but it seems like SOMEONE has to know, and I'm frustrated that I can't figure it out! 

[Katy]

No one will know the answers until more people on immunosuppresants take it.  He can always get a booster shot.

If he's able to quit taking it for a few months to get full immunity with very little effect it might be worth it.  He should discuss the possibility with his rheumatologist AND his general practitioner (IME their advice sometimes differs).  And what their advice is might depend more on his recent lab results than anything else.

 

IE:  In the middle of a flare he might get much different advice than in remission.

Edited December 23, 2020 by Katy

[Drama Llama]

Has he had conversations with his doctors about other immunizations and biologics?  I haven't had conversations about the covid vax in particular, but I know that for other vaccines, unless they were live, the feeling was that it was safe to take them on immunosuppressants, but that it was likely that they wouldn't work well.  We never talked about a break in biologics, because that wasn't realistic, but we did talk about trying to time things like flu vax for when he was on less steroids.  Mostly, though, we relied on the strategy of limiting who he was in contact with, and making sure those people were vaccinated for things like flu, chicken pox, or pertussis, which were probably the VPD's that posed the biggest threat before covid. 

[kokotg]

16 minutes ago, Katy said:

No one will know the answers until more people on immunosuppresants take it.  He can always get a booster shot.

If he's able to quit taking it for a few months to get full immunity with very little effect it might be worth it.  He should discuss the possibility with his rheumatologist AND his general practitioner (IME their advice sometimes differs).  And what their advice is might depend more on his recent lab results than anything else.

 

IE:  In the middle of a flare he might get much different advice than in remission.

I know no one knows the answer yet about the covid vaccine specifically; I'm more trying to figure out how it's worked with other vaccines and whether whatever benefit he might get from temporarily stopping the taltz would be erased as soon as he restarts. I mean...is the measles vaccine he got as a kid less effective because he takes an immunosuppressant now? Or do you keep the immunity once you establish it? I just don't know enough about how biologics work to know. He doesn't have a rheumatologist--just a dermatologist for the psoriasis (who hasn't been particularly helpful so far with this). And then he's seen my NP a time or two for other stuff, but doesn't have much of a relationship established with her. 

[kokotg]

11 minutes ago, BaseballandHockey said:

Has he had conversations with his doctors about other immunizations and biologics?  I haven't had conversations about the covid vax in particular, but I know that for other vaccines, unless they were live, the feeling was that it was safe to take them on immunosuppressants, but that it was likely that they wouldn't work well.  We never talked about a break in biologics, because that wasn't realistic, but we did talk about trying to time things like flu vax for when he was on less steroids.  Mostly, though, we relied on the strategy of limiting who he was in contact with, and making sure those people were vaccinated for things like flu, chicken pox, or pertussis, which were probably the VPD's that posed the biggest threat before covid. 

He's only talked about it before to establish that it was safe to take the flu vaccine. He has the same understanding that the vaccine should be safe for him to take since it's not a live vaccine...it's just a matter of maximizing the effectiveness. He's very lucky in that he COULD stop taking it temporarily and it would likely not be a big deal as long as he only skipped a month or two...whereas he can't really limit his contact with people until/unless we're sure he's immune since he works at a school. 

[prairiewindmomma]

There are numerous studies that talk about a month long pause with the influenza vaccine to boost efficacy.

I haven’t heard of any studies yet with the Covid vaccine.

My rheumatologist sent a blanket letter to the patients of her practice that we should vaccinate unless we have outstanding factors (like severe vaccine reactions, etc). 
 

Personally, I plan to stop a week before and wait two weeks after. If he works at a school, I wouldn’t take a break for the first dose. I would for the second. 

[Pawz4me]

FWIW -- My rheumatologist says people who are on biologics should continue their medication as normal when it's their turn to get the Covid vaccine, but that people on methotrexate are being advised to skip it for two weeks. I'm not currently on methotrexate, so I didn't ask how that two weeks of skipping is supposed to fall before/after/around the vaccine.

My opinion might change, but currently I'm inclined to follow my rheumy's advice and continue with my biologic as usual when it's time to get the vaccine. I've skipped it for a week before when I was on antibiotics and didn't have a problem, but I'm very leery or skipping more than that.