Can I Get a COVID-19 Vaccine While on Psoriasis Treatment?
Still deciding whether a COVID-19 vaccine is right for you? You’re not alone. In a recent survey of psoriasis community members, 68.2 percent of people with psoriasis said they planned to get vaccinated for COVID-19. But 22.4 percent were still undecided, and 8.4 percent did not plan to get vaccinated.
There were three common reasons people gave for being reluctant. Some were concerned their psoriasis might put them at higher risk for side effects. Others were worried about getting a vaccine while undergoing psoriasis treatment. Still others thought getting the shots might trigger a flare-up. So, we took these concerns to expert Joel Gelfand, M.D., a professor of dermatology and epidemiology at the University of Pennsylvania Perelman School of Medicine and co-chair of the National Psoriasis Foundation COVID-19 task force. Here’s what Gelfand told us about getting a COVID-19 vaccine when you have psoriasis.
In general, who is a COVID-19 vaccine safe for and who is it not safe for?
Basically, the vaccines are safe for everyone. There's only a really teeny, tiny group of people for whom the vaccine is not safe. That's people who have a known allergy to a component of the vaccine. That is very, very rare because these components aren't commonly used. So, anyone with psoriatic disease is a good candidate for any of the three vaccines available.
Does this include people who are currently on a psoriasis treatment?
None of these vaccines are live, which means that they're all compatible with being on psoriatic disease treatment. Patients see commercials that say: Don't take this medication if you're getting a live vaccine. None of these are live vaccines, and so they're perfectly safe in combination with psoriatic treatment.
Could taking psoriasis medication affect someone’s immune response to the vaccine?
A question that we've been trying to sort out for our patients is: If you're on an immune-modulating treatment, would that mean that the vaccine would not work as well? And that's been hard to answer definitively because the clinical trials generally didn't have people on these types of therapies. That being said, we can look back at the large volume of literature on flu vaccines and pneumococcal vaccines. And the reality is that for almost all the treatments we use for psoriatic disease, none of them meaningfully alter vaccine response.
I think the good thing about the COVID-19 vaccines is that they're so effective against COVID-19 that we think it's pretty unlikely that being on one of these treatments is going to meaningfully alter how you respond. And so, our recommendations for all the vaccines are basically to stay on your therapy for psoriatic disease. Getting vaccinated is not a reason to stop.
The exception is probably methotrexate, which is still commonly used. And we know from a study out of Korea that if you hold your methotrexate for two weeks after getting a flu shot, you may have a marginally better antibody response than if you had continued methotrexate. So, the question is: What does that mean [for COVID-19 vaccines]?
So, does that mean people on methotrexate should stop taking it if they’re getting vaccinated?
In all cases, I would say talk to your doctor before holding your medication. There’s only one exception for doctors and their patients to consider. And that is if you're getting the Johnson & Johnson vaccine, and you're 60 or older, and you have a major underlying health problem that puts you at higher risk for COVID-19. So, these are people who may be obese or have COPD or diabetes or coronary disease. And since J&J is only a one-shot vaccine, there you potentially could say, “All right, well, hold [the methotrexate] for two weeks and maybe you'll have a better response.”
Currently, though, the J&J vaccine is not available. On April 13th, 2021, the FDA and CDC put a pause on the use of the J&J vaccine while reports of an extremely rare type of severe blood clot are being investigated. The event was reported in six patients out of the more than 6.8 million who have received this vaccine to date. Until we have more information about the availability of the J&J vaccine, people should get an mRNA-based vaccine, made by either Pfizer or Moderna, as soon as it is available to them.
Is someone’s psoriasis more likely to flare after getting vaccinated?
This is a very logical concern. You would think that getting a vaccine, since it triggers an immune response, might trigger an immune disease like psoriasis. But I've treated thousands of people with psoriasis over the years. I've never seen a patient come in and say, “My psoriasis flared because I got a vaccine.”
And we had this big expert committee and no one thinks it's an issue in our clinical experience. But then, also, when you look at the history of vaccines that have been developed, none of them really has evidence of triggering or aggravating psoriasis. The FDA and CDC have commented that in the mRNA vaccine studies that they didn't see any signs of imbalance in immune problems in people getting the vaccines versus placebo.
The reality is that in the long history of vaccines, it's never been an issue. And if someone has a very unique situation where, because of their unique genetics or something else going on, their psoriasis gets a little worse after their vaccine, that's a manageable problem.
What is not easy to manage is being infected with SARS-CoV-2, [the virus that causes COVID-19]. We just don't have good treatments for it. So, the best thing is not to get infected with it. Often, people get COVID-19 and their psoriasis flares. And I've seen that a bunch of times in my practice.
When you get an immunization, it's designed specifically for your body to be able to handle it. When you get a natural infection, that is a virus trying to screw with you. It's trying to manipulate your immune system to prevent your body from having a proper immune response. And that's why it's always much better to develop immunity by being vaccinated than by being infected.
Does it matter which brand of vaccine people with psoriasis get?
If you had all three vaccines in front of you, then the major differences from the patient's perspective are that Pfizer is two shots, three weeks apart, and Moderna is two shots, four weeks apart. J&J is one shot, and as I mentioned, is not available right now.
Pick the one you can get first. Because while you're trying to nuance this, you're at risk of coming down with COVID-19. The last thing you want to do is to get violently ill from COVID-19 the day you need to show up for your vaccine. It takes time to develop immunity, so you're vulnerable to COVID-19 until you get through that window after the vaccine. So, why would you want to delay it by another week or two, whatever it's going to be, when you have an option in front of you?
Should people be concerned about potential long-term side effects from the COVID-19 vaccines?
This issue has been brought up a few times in my practice. I tell people that in the long history of vaccines, which have been around for like a century, long-term side effects are not really a thing. You can see rare, unusual things happen within a week or two of a vaccine.
This is exactly what we are seeing with the J&J vaccine. Within about two weeks of receiving this vaccine, about one out of a million people experienced a severe type of blood clot. This side effect wasn’t identified in the initial trials because it is so incredibly rare. The FDA and CDC are showing an abundance of caution in pausing use of the J&J vaccine since we have two highly effective alternatives—the mRNA based vaccines from Pfizer and Moderna—that don’t appear to have this extremely rare side effect.
That being said, it's extremely uncommon or unheard of to see side effects from vaccines developing after that initial period. It just doesn't really happen, so there's no reason to think that would happen here.
Now, millions of people around the world are vaccinated already. I was vaccinated back in December. So, I guess the good news is that those who are frustrated about not having had the vaccine yet, now have the peace of mind that tens of millions of people have taken the vaccine.
Now, contrast that to getting COVID-19. I mean, we don't know what the risk of long-hauler syndrome is. It's not been well-defined, but clearly that's a phenomenon. So, that's what we need to be concerned about, which is the unknown of a new novel pathogen that wants to do us harm, causing long-term health effects.
Should someone get vaccinated if they’ve already been sick with COVID-19?
The recommendation is that if you're three months past COVID-19, you should get the vaccine. And it's really because developing immunity from a natural infection is typically not as good as getting it from a vaccine. Because the virus itself is successful by suppressing our immune reactions. That's why people get ill. And, so, when you're trying to deal with natural immunity, it's unlikely you're going to have as good a long-term effect as if you got a vaccination when your body is healthy and able to mount a proper immune response.
It's just been so tragic to see so many people suffering, not being able to avoid getting infected. But now we have vaccines. That's like the golden ticket out. If you get vaccinated, based on the data we have so far, once you're in the protection period, that seems to eliminate the risk of dying of COVID-19. So to me, that's what people should be thinking about.
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