Dosing Schedule Adjustments for Patients Receiving Vaccine

Covid-19 Vaccine

As readers of the AntonRx Report may know, we scan hundreds of articles each week to sleuth out information that is timely and important to specialty pharmacies. Earlier this week we ran across the first article we’ve seen that directly addresses Covid 19 and the specific impact to patients on a specialty therapy, in this case Rheumatoid Arthritis.

The article is a bit lengthy but offers a template for any specialty pharmacy to develop their own therapeutic protocol. Since virtually all specialty pharmacies are now accredited, it is incumbent on specialty pharmacies to develop such enhanced therapeutic protocols as new information becomes available.

The most noteworthy article element addressed medication dosing schedule adjustments for patients before / after receiving the Covid 19 vaccine.
“Medications include:
Methotrexate: Hold for one week after each vaccine dose for people with well-controlled disease.
JAK Inhibitors: Hold for one week after each dose.
Abatacept for subcutaneous delivery: Hold for one week before and one week after the first dose only; for IV delivery, time the first vaccine only to occur four weeks after the drug’s infusion, then postpone the subsequent infusion by one week, for a five-week gap.
Rituximab: Schedule vaccine about four weeks before next scheduled cycle and delay the drug two to four weeks after the vaccine series is completed, if possible.
Cyclophosphamide: Time drug administration about one week after each vaccine dose, if possible.
There were no recommendations to alter drug regimens for hydroxychloroquine, intravenous immunoglobulin (IVIG), prednisone less than 20 milligrams per day, sulfasalazine, leflunomide, mycophenolate, azathioprine, cyclophosphamide, TNF inhibitors, belimumab, oral calcineurin inhibitors, or IL-6R, IL-1, IL-17, IL-12/23, or IL-23.

It is possible that people taking immune-compromising medication may have a lower
response to the vaccine, the ACR Task Force notes.”

Does your specialty pharmacy support drug-specific dosing adjustments for your RA patients receiving the vaccine?
If not, why not?

Our suggestion is to use this template to prepare such enhanced protocols for each therapeutic category you support including desktop workflows for patient coordinators and pharmacists to determine if a dosing schedule adjustment is warranted. Notes to the patient file should include patient status and follow up to ensure that the specialty therapy resumes. A call to the treating physician may be required as well. Each manufacturer should be able to provide their dosing recommendation for their drug.

Developing a full suite of protocols will be challenging but is essential to a high-quality therapeutic management program.

8 Things People With Rheumatoid Arthritis Must Know About the COVID-19 Vaccines

Learn about the safety, effectiveness, and importance of getting the COVID-19 vaccines if you or a loved one is living with rheumatoid arthritis.

By Meryl Davids Landau
Medically Reviewed by Alexa Meara, MD

February 11, 2021 — With two COVID-19 vaccines already authorized by the U.S. Food and Drug Administration (FDA) and others potentially on the way, immunizations have begun in the United States and around the world. People living with rheumatoid arthritis (RA) and their loved ones may have questions about whether the vaccines are safe and effective for those with this condition.

Based on a substantial body of evidence, there is no need to hesitate, says Onyema Ogbuagu, MBBCh, an infectious disease specialist and a principal investigator of the Pfizer COVID-19 vaccine trial at the Yale School of Medicine in New Haven, Connecticut.

People with rheumatoid arthritis should roll up their sleeves as soon as a shot is offered to them, he says. With COVID-19 a widely circulating, deadly disease, it’s important to get protection as soon as you can. “Don’t delay. Do it yesterday,” he urges.

Below are expert answers to your pressing questions about the COVID-19 vaccines……..


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