Jakarta, CNN Indonesia —
people with lupus (Odapus) often face the dilemma of Covid-19 vaccination. On the one hand, vaccination is needed to ‘train’ the body’s immune system to fight SARS-CoV-2.
On the other hand, lupus is an autoimmune disease in which there are elements of drugs that function to suppress the immune system so it doesn’t eat away at the body. But seeing the pandemic conditions, is it still recommended for odapus to be vaccinated against Covid-19?
Professor Harry Subagio, specialist in internal medicine-consultant rheumatology, said patients with inflammatory autoimmune rheumatic disease (Autoimmune Inflammatory Rheumatic Disease/AIIRD) including lupus are still advised to receive the Covid-19 vaccine.
“Although there is no complete data on the efficacy and safety of the Covid-19 vaccine in AIIRD patients, the benefits of vaccinating are greater than the risk of getting Covid-19,” said Harry in a webinar with the Indonesian Rheumatology Association and Novartis, Tuesday (14/12). .
Harry also explained several reasons why the Covid-19 vaccine is very important for odapus and other AIIRD patients.
Those with AIIRD are more susceptible to infection and experience severe to fatal symptoms or death. Harry said Denmark reported that patients with AIIRD were more susceptible to being hospitalized due to Covid-19 than non-AIIRD patients.
A study in 7 Spanish health centers found an increase in patients with AIIRD by 1.31 percent. Reports of improvement were also found in Germany and Italy.
Then the death rate is also high as reported by the Global Rheumatology Alliance that there were a total of 600 cases from 40 countries, with 46 percent being hospitalized and 9 percent dying.
In Madrid, Spain, from 455 cases, deaths were 13.2 percent of non-AIIRD patients and 18.1 percent of AIIRD patients.
Patients with AIIRD who were hospitalized or had severe symptoms to death due to Covid-19 were found to be associated with comorbidities (chronic lung disease, hypertension, diabetes, obesity, cardiovascular disease), as well as the consumption of several types of drugs for AIIRD therapy such as methotrexate, high-dose prednisone. .
“Is the risk of Covid-19 disease increased in AIIRD patients? Yes. Is Covid-19 disease more severe in AIIRD patients? Yes. Is Covid-19 infection associated with manifestations of rheumatic and autoimmune diseases? Yes. So it is very rational to give Covid-19 vaccinations. 19 for AIIRD patients,” he said.
What kind of vaccine is effective for AIIRD patients?
1. Non-live vaccines
Non-live vaccine or an inactivated vaccine is recommended for AIIRD patients. Non-live vaccine means the vaccine contains destroyed viral RNA.
This type of vaccine has shown a good immune response in patients, except in patients taking rituximab and high-dose corticosteroids.
2. Vaksin mRNA
The mRNA vaccine shows good efficacy and is used in the general population. With this in mind, mRNA vaccines are also recommended for AIIRD patients.
Then, here are some things that need to be understood regarding the Covid-19 vaccination for odapus and other AIIRD patients.
– As far as possible in remission, remission means the autoimmune condition is under control and this has been through the examination of the treating doctor.
– Use of available vaccines, especially non-live vaccines.
– The risk of flare or relapse is very small.
– Need to monitor post-vaccination patients.
– For drugs, DMARD drugs can be continued before and after vaccination, except for corticosteroids (dose adjustment), cyclophosphamide, rituximab, abatacept, jak-inhibitors and MTX (time adjustment).
– Continue to comply with health protocols.
What if odapus and other AIIRD patients are vaccinated and are not in remission?
Until now, said Harry, there has been no research examining the impact of vaccines on uncontrolled autoimmune. But Harry said the vaccine would theoretically be futile.
“The disease is still active, has kidney, lung in severe condition, unstable, not yet in remission, should not be given. Because you are still taking medicine, vaccination will not provide immunity. Antibodies are suppressed by drugs,” he added.
(the / agn)
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