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Erschienen in:
07.09.2021 | COVID-19 | Empfehlungen und Stellungnahmen von Fachgesellschaften
Updated recommendations of the German Society for Rheumatology for the care of patients with inflammatory rheumatic diseases in the context of the SARS-CoV-2/COVID-19 pandemic, including recommendations for COVID-19 vaccination
Erschienen in: Zeitschrift für Rheumatologie | Sonderheft 2/2021
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Table 1.
Table 1
Core recommendations of the DGRh for the care of patients with inflammatory rheumatic diseases in the context of the SARS-CoV-2/COVID-19 pandemic
|
#
|
Recommendation
|
LoAa
(± SD)
|
GoR
|
|---|---|---|---|
|
1
|
Patients with inflammatory rheumatic diseases (IRD) should follow the behavioural and precautionary measures described by the Robert Koch Institute to avoid infections. This also applies in the case of a positive SARS-CoV‑2 IgG antibody detection. Special additional measures are not necessary
|
9.9
(± 0.43)
|
⇑
|
|
2
|
To interrupt chains of infection and contain a new possible wave of infection, patients may be advised to use the “Corona Warning App” or similar digital applications
|
8.95
(± 1.25)
|
⇔
|
|
3
|
The individual risk for infection or severe disease progression can be estimated based on general (such as age, multimorbidity, obesity, smoking) and disease-specific (e.g. high activity of IRD, severe systemic disease) risk factors
|
9.43
(± 0.85)
|
⇑⇑
|
|
4
|
Initiation or change of antirheumatic therapies should neither be omitted nor delayed due to the COVID-19 pandemic
|
9.9
(± 0.43)
|
⇑⇑
|
|
5
|
Before administering rituximab, an individual risk–benefit assessment should be carried out due to the increased risk of a severe COVID-19 course, and the use of alternative therapies should also be examined
|
9.81
(± 0.5)
|
⇑
|
|
6
|
In patients without signs of infection, even with contact with SARS-CoV‑2 positive persons, the existing antirheumatic therapy should be continued unchanged. This also applies to the therapy with glucocorticoids in the therapeutically necessary dose
|
9.76
(± 0.53)
|
⇑
|
|
7
|
In patients tested positive for SARS-CoV‑2 by PCR without signs of infection, pausing or delaying ts- or b‑DMARD therapy for the duration of the mean incubation period of SARS-CoV‑2 infection (e.g. 5–6 days) should be considered. Generally, csDMARDs should not be discontinued in the absence of signs of infection
|
9.38
(± 0.72)
|
⇑
|
|
8
|
In patients with confirmed active COVID-19, DMARD therapy should be paused and leflunomide washed out if necessary. Continuous GC therapy ≤ 10 mg/day used for the treatment of the rheumatological disease should be continued at the same dose
|
9.43
(± 0.85)
|
⇑
|
|
9
|
Rheumatologists should always be involved in the decision to maintain, reduce or pause antirheumatic therapy in the context of COVID-19
|
9.89
(± 0.31)
|
⇑
|
|
10
|
A general recommendation for screening patients with IRD for SARS-CoV‑2 antibodies after infection cannot be given at present due to a lack of data on antibody formation and persistence (especially under immunosuppression)
|
9.33
(± 1.21)
|
⇑
|
|
11
|
Patients with IRD and positive test for SARS-CoV‑2 (PCR, rapid antigen test, antibody test) should be documented in the COVID-19 registry of the DGRh (COVID19-rheuma.de)
|
9.76
(± 0.61)
|
⇑
|
|
12
|
Patients with IRD should be vaccinated against SARS-CoV‑2 following the vaccination recommendations of the STIKO
|
10
(± 0)
|
⇑⇑
|
|
13
|
The presence of IRD alone does not imply a preference for one of the vaccines approved in Europe. With the aim of rapid immunisation in urgently needed rituximab therapy and in patients over 60 years of age with confirmed APS or immune thrombocytopenia, the use of an mRNA vaccine should be considered as a precaution in these situations
|
9.48
(± 0.85)
|
⇑
|
|
14
|
General discontinuation of DMARD therapy solely due to vaccination—as DMARDs and immunosuppressants can attenuate the measurable humoral immune response after COVID vaccination (with this most clearly affecting rituximab and least affecting anti-cytokine biologics)—is not recommended, as it is not known to what extent this affects actual vaccination protection
|
9.71
(± 0.55)
|
⇑⇑
|
|
15
|
Pausing methotrexate for 1–2 weeks after each vaccination, JAK inhibitors for 1–2 days before and 1 week after each vaccination, and abatacept for 1 week before and after each vaccination can be considered if IRD is in stable remission. But this is not mandatory. Good disease control has priority over a possibly attenuated immune response, even in the context of vaccination
|
9.1
(± 0.92)
|
⇔
|
|
16
|
The vaccination series should begin at least 4 months after the last rituximab administration and rituximab should ideally be given at the earliest 4 weeks after completion of the vaccination series. In individual cases and patients at risk, this may be deviated from
|
9.29
(± 0.93)
|
⇑
|
|
17
|
SARS-CoV‑2 antibody titres should not be determined regularly to monitor vaccination success. It is not yet clear to what extent the results are predictive of protection against infection or disease
|
9.48
(± 0.79)
|
⇑
|