Patients with chronic inflammatory diseases (CIDs) receiving treatment with immunosuppressive medications have impaired SARS-CoV-2 vaccine-induced immunity, with glucocorticoids and B-cell depletion therapy severely inhibiting optimal responses, according to study results presented at the American College of Rheumatology (ACR) Convergence 2021, held virtually from November 3 to 10, 2021.

The researchers sought to determine the effectiveness of SARS-CoV-2 vaccines in patients with CIDs for the risk-stratification of those with impaired protection and to provide clinical guidance on medication management.

In the prospective COVID-19 Vaccine Responses in Patients With Autoimmune Disease (COVARIPAD) study, researchers collected blood samples from 197 adults with CIDs and 53 healthy control participants prior to their initial vaccine dose and then 1 to 2 weeks following their second dose. Serum anti-SARS-CoV-2 spike (S) immunoglobulin (Ig)G+ binding and neutralizing antibody titers were quantified to evaluate both the magnitude and the quality of humoral responses after vaccination.


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Patients with CIDs had a range of immunologic diagnoses, including inflammatory bowel disease, rheumatoid arthritis, spondyloarthritis, uveitis, systemic lupus erythematosus, connective tissues diseases, Sjögren syndrome, vasculitis, autoinflammatory syndrome, psoriasis, antiphospholipid syndrome, and multiple sclerosis.

In patients with CIDs compared with control participants, a 3-fold decrease in anti-S IgG titers (P =.0046) and SARS-CoV-2 neutralization (P <.0001) to the D614G common variant were reported. The strongest effects were reported with

B-cell depletion and glucocorticoids, with 36-fold and 13-fold reductions, respectively, in humoral responses (P <.0001).

According to multivariate regression analyses, Janus kinase (JAK) inhibitors and antimetabolites, including methotrexate, were also associated with blunted antibody titers (P <.0001 and P =.0023, respectively). The use of other targeted therapies, including tumor necrosis factor (TNF) inhibitors, interleukin (IL)-12/23 inhibitors, and integrin inhibitors, had only modest effects on antibody formation and neutralization. 

The researchers concluded that based on the findings from the COVARIPAD study, they are “currently determining cross-variant neutralization, long-term antibody and neutralization titers, and T cell responses in this cohort.”

Disclosure: Some of the study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.

I often hear patients asking, “Why am I taking this medication?”  Whether it is a medication prescribed by a primary care physician, specialist, or emergency medicine provider, this question needs to be answered and understood by all patients. Prescription labels for medications taken as-needed typically include the indication for use, but prescriptions for chronic illnesses typically do not. This information is especially important when patients are on multiple medications. The issue comes down to health literacy.

Studies have shown that more than 75% of patients lack understanding about prescription label instructions, and some patients stop taking medications if they don’t know what it is prescribed for.1 This lack of information is a source of frustration for patients, their caretakers/families, and their providers. Many older patients in my practice ask me about their medications. After explaining the indication for each medication, I write the reason for the prescription on the bottle with a marker if they have their medicine with them or I indicate the information on their paperwork. The simple act of writing down the purpose for the medication helps patients understand why the agent is important to their heath and serves as a reminder over time.  

Misunderstanding the “why” may affect patient’s willingness to take needed medications. Medication nonadherence affects quality of life and leads to more than $100 billion in avoidable hospitalizations.2 Not knowing the “why” can lead to chronic illness exacerbations causing multiple office/emergency department visits or hospitalizations as well as increased time spent by office staff and/or pharmacy staff to address patient questions. To help reduce this burden, the Institute of Medicine encourages the standardization of prescription use instructions given that the medication label is a key source of information for patients.3 This practice can save time, confusion, and money for patients, families, providers, pharmacists, hospitals, and insurance companies.

Nurse practitioners (NP) can lead this transformation in their practice. Awareness that patients need information on the purpose of their medications is necessary for change to begin. After discussing this need with patients, colleagues, and support staff, the indication for use of each medication can be written on prescriptions for all patients. This act will serve as a reminder of the “why” and will help patients take control of their health care.


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Karen A. Bocchicchio MSN, FNP-C, APN-C, is a practicing clinician as well as lead clinician at a Penn Medicine primary care office in New Jersey. She is a clinical nursing adjunct for nurse practitioner students at Rowan University. She is also pursuing her DNP at Rutgers University.

References

1. Davis TC, Federman AD, Bass PF 3rd, et al. Improving patient understanding of prescription drug label instructions. J Gen Intern Med. 2009;24(1):57-62. doi:10.1007/s11606-008-0833-4

2. Cutler DM, Everett W. Thinking outside the pillbox–medication adherence as a priority for health care reform. N Engl J Med. 2010;362(17):1553-1555. doi:10.1056/NEJMp1002305

3. Institute of Medicine. Standardizing Medication Labels: Confusing Patients Less: Workshop Summary. The National Academies Press; 2008. https://doi.org/10.17226/12077.

Reference

Paley M, Deepak P, Kim W, et al. Immunosuppression attenuates antibody and neutralization titers in patients with chronic inflammatory disease following SARS-CoV-2 vaccination. Presented at: ACR Convergence 2021; November 3-10, 2021. Abstract 0457. 

This article originally appeared on Rheumatology Advisor