Abstract
Objective To develop guidance on the use of COVID-19 vaccines in patients with autoimmune rheumatic diseases (ARD).
Methods The Canadian Rheumatology Association (CRA) formed a multidisciplinary panel including rheumatologists, researchers, methodologists, vaccine experts and patients. The panel used the GRADE 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 four COVID vaccines approved in Canada as of March 25, 2021 (BNT162b2, mRNA-1273, ChAdOx1 and Ad26.COV2.S) over four virtual panel meetings.
Results 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 about 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 autoimmune rheumatic diseases to obtain their vaccination. Guidance on medications, implementation, monitoring of vaccine uptake and research priorities are also provided.
Conclusion This recommendation will be updated over time as new evidence emerges, with the latest recommendation, evidence summaries and EtD available on the CRA website.
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