TY - JOUR T1 - Does an adjustment to the dosing and timing of immunomodulatory drugs alter the immunogenicity of the COVID-19 vaccines in patients with autoimmune and inflammatory rheumatic disease (AIIRD)? JF - RMD Open JO - RMD Open DO - 10.1136/rmdopen-2022-002203 VL - 8 IS - 1 SP - e002203 AU - Andrew J Laster AU - Gordon K Lam AU - Heather S Gladue AU - Ahmad A Kashif AU - Erin P Siceloff AU - Virginia D Lackey AU - Cheryl R Robertson AU - Ashley L Toci AU - Leonard H Calabrese Y1 - 2022/05/01 UR - http://rmdopen.bmj.com/content/8/1/e002203.abstract N2 - Clinical trials leading to approval of the COVID-19 vaccines did not include immunocompromised individuals. Concerns have been raised that immunogenicity of the vaccines may be impaired in patients with autoimmune and inflammatory rheumatic disease (AIIRD) on immunomodulatory drugs. In December of 2020, our clinic recommended adjustments to the dosing/timing of select drugs to attempt to optimise vaccine response. The ACR COVID-19 Vaccine Clinical Guidance Task Force first provided recommendations in February 2021.1 Our recommendations were similar but differed in some key aspects (online supplemental table 1). In contrast, EULAR guidance states that ‘pausing or reducing immunosuppression may increase the risk of flare, and therefore it is generally advised not to, or only temporarily, interrupt or decrease your medication for this purpose…’2 As there is limited published data on the effects of adjustments to dosing and/or timing of immunomodulatory drugs in patients with AIIRD,3 we sought to characterise antibody responses to the SARS-CoV-2 spike protein in those who adjusted and did not make adjustments to their drug therapy in a community based rheumatology practice in Charlotte, North Carolina.Supplementary data[rmdopen-2022-002203supp001.pdf]We measured SARS-CoV-2 IgG antibody levels to the receptor-binding domain of the S1 spike antigen using a semiquantitative assay (Siemens Atellica; QUEST) in which a negative result is <1.00 and a positive result is reported as 1.00–20 or >20.4 This assay had a Pearson correlation coefficient of 0.8 when compared with viral neutralisation titers.5 All tests were performed by day 14 or later following completion of the two vaccine series using BNT162b2, mRNA-1273 or single dose Ad26COV2.S vaccine. Patients were excluded if they self-reported a prior clinical history of COVID-19 infection or if labs were drawn more than 6 months after their vaccine course was completed. We compared the number of antibody positive (Ab+) versus antibody … ER -