G.S. Hazlewood, MD, PhD, Associate Professor of Medicine, C. Barnabe, MD, MSc, Associate Professor of Medicine, C.E. Barber, MD, PhD, Assistant Professor of Medicine, Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, and Arthritis Research Canada, Richmond, British Columbia;
J.P. Pardo, LDO, Managing Editor, Centre for Global Health, University of Ottawa, Ottawa, Ontario.
J Rheumatol. 2021 Aug;48(8):1330-1339. doi: 10.3899/jrheum.210288. Epub 2021 May 15.
To develop guidance on the use of coronavirus disease 2019 (COVID-19) vaccines in patients with autoimmune rheumatic diseases (ARD).
The Canadian Rheumatology Association (CRA) formed a multidisciplinary panel including rheumatologists, researchers, methodologists, vaccine experts, and patients. The panel used the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach. Outcomes were prioritized according to their importance for patients and clinicians. Evidence from the COVID-19 clinical trials was summarized. Indirect evidence for non-COVID-19 vaccines in ARD was also considered. The GRADE evidence-to-decision (EtD) framework was used to develop a recommendation for the use of the 4 COVID-19 vaccines approved in Canada as of March 25, 2021 (BNT162b2, mRNA-1273, ChAdOx1, and Ad26.COV2.S), over 4 virtual panel meetings.
The CRA guideline panel suggests using COVID-19 vaccination in persons with ARD. The panel unanimously agreed that for the majority of patients, the potential health benefits of vaccination outweigh the potential harms in people with ARDs. The recommendation was graded as conditional because of low or very low certainty of the evidence on the effects in the population of interest, primarily due to indirectness and imprecise effect estimates. The panel felt strongly that persons with autoimmune rheumatic diseases who meet local eligibility should not be required to take additional steps compared to people without ARDs to obtain their vaccination. Guidance on medications, implementation, monitoring of vaccine uptake, and research priorities are also provided.
This recommendation will be updated over time as new evidence emerges, with the latest recommendation, evidence summaries, and EtD available on the CRA website.
为患有自身免疫性风湿病 (ARD) 的患者使用 2019 年冠状病毒病 (COVID-19) 疫苗提供指导。
加拿大风湿病学会 (CRA) 成立了一个多学科小组，成员包括风湿病学家、研究人员、方法学家、疫苗专家和患者。该小组使用 GRADE（评估、制定和评估推荐的分级）方法。根据对患者和临床医生的重要性，对结果进行了优先级排序。总结了 COVID-19 临床试验的证据。还考虑了 ARD 中使用非 COVID-19 疫苗的间接证据。使用 GRADE 证据决策 (EtD) 框架，在 4 次虚拟小组会议上，为截至 2021 年 3 月 25 日在加拿大批准的 4 种 COVID-19 疫苗（BNT162b2、mRNA-1273、ChAdOx1 和 Ad26.COV2.S）的使用制定了建议。
CRA 指南小组建议在 ARD 患者中使用 COVID-19 疫苗。小组成员一致认为，对于大多数患者而言，疫苗接种的潜在健康益处超过了 ARD 患者的潜在危害。由于对目标人群的影响证据存在间接性和估计效果不精确，因此该建议被评为有条件的。小组成员强烈认为，符合当地资格的自身免疫性风湿病患者与没有 ARD 的患者相比，不应需要采取额外措施来接种疫苗。还提供了关于药物、实施、疫苗接种监测和研究重点的指导。
随着新证据的出现，该建议将定期更新，最新的建议、证据摘要和 EtD 可在 CRA 网站上获取。
