The National Psoriasis Foundation (NPF) COVID-19 Task Force has updated its guidance statements to recommend that individuals with psoriasis or psoriatic arthritis receive the first COVID-19 vaccine offered to them, as all 3 currently available vaccines are highly effective at preventing serious COVID-19 outcomes like hospitalization and/or death. Information about methotrexate use following vaccination also was included in the update.
Co-Chair of the NPF COVID-19 Task Force Joel M. Gelfand, MD, MSCE, said that the most common concerns expressed by his patients with psoriasis or psoriatic arthritis are: 1) will the vaccine flare my psoriasis?; and 2) what is the long-term safety of the vaccines?
“There is no evidence or reason to believe that the COVID-19 vaccines will flare a patient’s psoriasis,” explained Dr Gelfand, who also is professor of dermatology and epidemiology at the University of Pennsylvania Perelman School of Medicine. Regarding safety issues, “In the long history of vaccines, safety issues typically arise within 1 to 2 weeks of vaccination. There is no reason to believe that there will be long-term side effects associated with these vaccines.”
“Patients also need to know that all 3 vaccines are highly effective,” Dr Gelfand said. “In the clinical trials, no vaccinated patient, not one of the tens of thousands of patients who received the COVID-19 vaccines, were hospitalized or died from COVID-19. In contrast, COVID-19 is known to flare psoriasis and has a significant risk for chronic disability [ie, “long haulers”, severe respiratory illness requiring hospitalization, and death].”
“I also let the patient know that I was first in line to get vaccinated once I was eligible,” Dr Gelfand noted. “Delaying vaccination to receive a particular vaccine puts individuals at unnecessary risk of death from COVID-19.”
Updates for Patients Taking Methotrexate
The updates were released in response to the recent Emergency Use Authorization of Johnson & Johnson’s Janssen COVID-19 vaccine. In most cases, the Task Force recommends that patients scheduled to receive the new vaccine continue taking their biologic or oral therapies for psoriasis and/or psoriatic arthritis.
However, patients aged 60 years or older who are taking methotrexate and have well-controlled psoriatic disease as well as at least 1 comorbidity associated with an increased risk for severe complications from COVID-19 outcomes may, in consultation with their prescriber, consider pausing methotrexate use for 2 weeks after receiving the Janssen COVID-19 vaccine to potentially improve vaccine response, according to the Task Force.
This guidance is based on data from influenza clinical trials suggesting that patients with rheumatoid arthritis who stopped taking methotrexate for 2 weeks after influenza vaccination achieved a marginally better antibody response of unknown clinical significance. It is unclear whether the same benefits found with pausing methotrexate for 2 weeks following influenza vaccination also apply to the COVID-19 vaccines.
It is unclear whether having psoriatic disease meaningfully alters the risk for SARS-CoV-2 infection or severe COVID-19 disease; however, data generally suggest that patients with psoriasis and/or psoriatic arthritis have similar rates of SARS-CoV-2 infection and COVID-19 outcomes as the general population, according to the Task Force.
National Psoriasis Foundation. National Psoriasis Foundation COVID-19 Task Force: Schedule of Updates to Guidelines. National Psoriasis Foundation; March 4, 2021. Accessed March 9, 2021.