PT  - JOURNAL ARTICLE
AU  - Glen S.  Hazlewood
AU  - Jordi  Pardo Pardo
AU  - Cheryl Barnabe
AU  - Orit Schieir
AU  - Claire E.H.  Barber
AU  - Sasha Bernatsky
AU  - Ines Colmegna
AU  - Carol Hitchon
AU  - Mark Loeb
AU  - Dominik Mertz
AU  - Laurie Proulx
AU  - Dawn P.  Richards
AU  - Rosie Scuccimarri
AU  - Peter Tugwell
AU  - Holger J.  Schünemann
AU  - Reza D.  Mirza
AU  - Alan L.  Zhou
AU  - Roko P.A.  Nikolic
AU  - Megan Thomas
AU  - Helena Chase
AU  - Maede Ejaredar
AU  - Robby Nieuwlaat
TI  - Canadian Rheumatology Association Recommendation for the Use of COVID-19 Vaccination for Patients With Autoimmune Rheumatic Diseases
AID  - 10.3899/jrheum.210288
DP  - 2021 May 15
TA  - The Journal of Rheumatology
PG  - jrheum.210288
4099  - http://www.jrheum.org/content/early/2021/05/27/jrheum.210288.short
4100  - http://www.jrheum.org/content/early/2021/05/27/jrheum.210288.full
AB  - Objective To develop guidance on the use of coronavirus disease 2019 (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 (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. 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 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. 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.