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AB0900 (2022)
A temporary antirheumatic drugs withdrawal does not cause an excess of disease flares in patients with psoriatic arthritis undergoing Covid-19 mRNA vaccination
R. Bixio1, A. Milanesi2, O. Viapiana1, C. Montecucco2, S. Bugatti2, M. Rossini1
1Università degli studi di Verona, Rheumatology section, Verona, Italy
2IRCCS Policlinico San Matteo Foundation, Division of Rheumatology, Pavia, Italy

Background: The best way to manage disease-modifying antirheumatic drugs (DMARDs) in patients with rheumatic and musculoskeletal diseases (RMDs) undergoing the Coronavirus disease (Covid)-19 vaccination and the recommendations regarding the use and timing of immunomodulatory therapies around the time of vaccination are still a matter of debate, due to the difficulties in balancing the vaccination efficacy and safety.


Objectives: To assess the impact of different strategies of antirheumatic treatment management on disease activity around the time of vaccination for Coronavirus disease (Covid)-19 in patients with psoriatic arthritis (PsA).


Methods: We prospectively evaluated patients with PsA in remission or low-disease activity candidate to receive Covid-19 vaccination with mRNA vaccines. Methotrexate (MTX) and leflunomide were withheld 7 days after each dose, whilst biological DMARDs (bDMARDs), were either continued (46.8% of the patients) or withheld (53.2%) from the day of the first dose until 7 days after the second dose. Patients were reassessed after 3 months from enrollment or in case of disease flare.


Results: After the second dose of Covid-19 vaccination 7 patients (5.6%) (6 females) had an articular disease flare each (mean involved joints: 1.29), one patient presented a concomitant worsening of psoriasis, and four patients had an isolated worsening of their psoriasis. All patients received additional treatments with oral GC (n=2) or non-steroidal anti-inflammatory drugs (n=5). Two flares lasted more than one week and required a modification of the ongoing bDMARD. Articular flare incidence (6.8% vs 3%, p=0.259), involved joints (1.4 vs 1.5, p=0.846), disease flare severity, and changes in antirheumatic therapies (1 vs 1, p=0.928) did not differ significantly between the two different bDMARD management strategy groups (continued vs temporary withheld). There was no significant difference in disease activity score for psoriatic arthritis (DAPSA) and C-reactive protein (CRP) after vaccination, but patients who flared up had a higher mean basal DAPSA (7.3 vs 4.1, p=0.046). On binomial logistic regression analysis, we did not find any significant association with gender, age, basal CRP, basal DAPSA, active psoriasis, conventional synthetic DMARDs, or bDMARDs and disease flare.


Conclusion: Our findings suggest that a temporary short halt of bDMARDs could be a viable option in patients with well-controlled PsA undergoing Covid-19 vaccination without increasing the risk of flares, which could be useful to increase T cell response and antibody titres after Covid-19 vaccination.


Disclosure of Interests: None declared


Citation: , volume 81, supplement 1, year 2022, page 1578
Session: Psoriatic arthritis - treatment (Publication Only)