Study: Patients Taking Immunosuppressive Drugs May Have Limited COVID-19 Vaccine Response

A study published in Jama Network Open found that nearly 3% of insured adults in the United States under the age of 65 years take medications that weaken their immune system. According to the study’s authors, drug-induced immunosuppression could potentially elevate the risk of severe COVID-19 symptoms and hospitalization if these individuals become infected.

Data for the study was gathered from more than 3 million patients with private insurance. The investigators focused on patients' use of immunosuppressive drugs, including chemotherapy medications and steroids such as prednisone, and found that nearly 90,000 people met the study criteria for drug-induced immunosuppression. Two-thirds of these patients took an oral steroid at least once, and more than 40% of patients took steroids for more than 30 days in a year.

“This study gives us previously unavailable information about how many Americans are taking immunosuppressive medications,” said Beth Wallace, MD, a rheumatologist at Michigan Medicine, in a press release. “It also reinforces that many Americans continue to take oral steroids, which are associated with serious [adverse] effects and can often be avoided or substituted with alternative medications.”

At the time of their investigators’ analysis, a vaccine against COVID-19 was not yet available outside clinical trials. However, according to the investigators, the growing evidence shows that taking immunosuppressive drugs may reduce the efficacy of the COVID-19 shot. They mention several strategies that are currently under evaluation for efficacy, including holding medications around the time of vaccination and giving an extra booster shot.

“We're starting to realize that people taking immunosuppressive drugs may have a slower, weaker response to COVID[-19] vaccination, and, in some cases, might not respond at all,” Wallace said in the release. “We don't have a full picture on how these drugs affect the vaccine's effectiveness, so it's difficult to formulate guidelines around vaccinating these patients.”

Wallace also expressed concern over how this group of immunosuppressed patients should proceed following the CDC's relaxation of masking and distancing guidelines for vaccinated people.

“The CDC acknowledges this cohort might not be as protected as other fully vaccinated people, but there are no set recommendations for what precautions they should take,” Wallace said in the release. ”For now, this is going to be an individual decision people make with their doctor.”

The investigators said that moving forward, future researchers need to look prospectively at vaccine response in this vulnerable population.

“Until we know more about this, we really won't be able to say if immunosuppressed people are actually protected,” Wallace said in the release.

REFERENCE

Nearly 3% of Americans take immune-weakening drugs that may limit COVID vaccine response [news release]. May 20, 2021. Accessed May 24, 2021. https://eurekalert.org/pub_releases/2021-05/mm-u-n3o051921.php