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Fab webinar on COVID + vaccinations 
@khyrich on @rheum_covid / @eular registry:
Enter data
http://bit.ly/2M6HIPU
Prev work showed inc risk death if
Older / 
comorbidities / high steroid (>10mg pred/day)
..... https://twitter.com/RheumatologyUK/status/1354740753973436423
@khyrich on @rheum_covid / @eular registry:
Enter data
http://bit.ly/2M6HIPU Prev work showed inc risk death if
Older / comorbidities / high steroid (>10mg pred/day)..... https://twitter.com/RheumatologyUK/status/1354740753973436423
... Today's paper http://bit.ly/3clZaL0
>4,000pts, outcome = death.
Inc risk death if
High dose steroid, esp if CTD
Using MTX as comparator, most drugs similar EXCEPT RTX
RTX sig mortality (CTD / IA) BUT it is pts on RTX who die, not RTX causing it (dx contributes)
http://bit.ly/3clZaL0 >4,000pts, outcome = death.
Inc risk death if
High dose steroid, esp if CTDUsing MTX as comparator, most drugs similar EXCEPT RTXRTX sig mortality (CTD / IA) BUT it is pts on RTX who die, not RTX causing it (dx contributes)
Most drugs comparable EXCEPT cont...
Immunosuppressants in CTD e.g. MMF/CYC
SPZ: bit of a surprise, higher if 
: may be explained by inc use (avoiding MTX e.g. co-existing 
dx), no change to existing guidance/shielding scores
No benefit from HCQ (
was wrong)
Immunosuppressants in CTD e.g. MMF/CYCSPZ: bit of a surprise, higher if : may be explained by inc use (avoiding MTX e.g. co-existing dx), no change to existing guidance/shielding scoresNo benefit from HCQ (was wrong)
@drjamesgalloway on vaccines
mRNA (Pfizer/Moderna)
viral vector vaccine (Oxford) – only the vector is live, so it doesn’t carry live coronovirus
protein-based (Novovax)
Report cases of COVID post vaccine https://bit.ly/3aauJod
.....
mRNA (Pfizer/Moderna)viral vector vaccine (Oxford) – only the vector is live, so it doesn’t carry live coronovirusprotein-based (Novovax)Report cases of COVID post vaccine
https://bit.ly/3aauJod .....
Push for 21 days was to facilitate faster trials, but immunologically it may be advantageous to have a longer gap. Offset may mean it takes longer to mount a sufficient response.
Advise all pts to have if offered
Elderly have poorer response....
Advise all pts to have if offeredElderly have poorer response....
Guidance:
Clinician @WeAreARMA http://bit.ly/3putab1
Pt #SDM @VersusArthritis https://bit.ly/39rCPtB
Green book https://bit.ly/3t4ZKSZ
RTX: give vaccine first; or wait 2-3 months for B cell repopulation before vaccinating (and shield)
....
Clinician @WeAreARMA
http://bit.ly/3putab1 Pt #SDM @VersusArthritis
https://bit.ly/39rCPtB Green book
https://bit.ly/3t4ZKSZ RTX: give vaccine first; or wait 2-3 months for B cell repopulation before vaccinating (and shield)....
RTX: ideally maintain shorter dosing, but logistically v difficult to executeVaccination in heavily immunosuppressed pts likely to have limited efficacy, so advice is to continue shieldingDelay non-urgent IM/PO steroid if poss, but give if needed...
IA steroid likely to be less problematic, but limited evidence Autoimmune dx/immunosupp not represented in trialsNo current guidance / evidence in favour of pausing or stopping other meds@RheumatologyUK covid guidance
http://bit.ly/3ah1vE4 Well chaired @lizzymacphie
