Vaccine vs. Arthritis Medication, Which Would you Chose?
With flu season about to be in full
swing, and Dr. Cohen encouraging the students to go get their vaccinations, I
began to wonder how getting an inoculation would affect those diagnosed with
Rheumatoid Arthritis. If this
autoimmune disease occurs because the patient’s body has an over-active immune
system, which causes anti-IgG IgM to be secreted from B cells, then should
people with RA who are taking immunosuppressive drugs receive vaccinations?
I was able to do some research on
Enbrel.com and found that before taking Enbrel people should talk to a doctor
if they “[h]ave recently received or are scheduled for any vaccines. All
vaccines should be brought up-to-date before starting ENBREL. Patients taking
ENBREL should not receive live vaccines.”
This drug is taken over the course of several years in order to prevent
the progression of the disease. With
this immunosuppressor being a long-term treatment, clearly the drug is being
used over the course of many flu seasons.
Doing further research on other
forums, it seemed to be that there are two types of influenza vaccines: dead or
live. The killed virus strain was
the form of inoculation that was recommended for those who have chronic
illnesses; however, the Center for Disease Control stated that there is a “high
risk from flu complications” for those who take Enbrel, among other
immunosuppressive prescriptions.
Is it worth the risk to stop taking
immunosuppressors for a few months in order to get a vaccine: keeping in mind
that there could be a progression in the rheumatoid arthritis? Or, is it less
risky to continue with the drugs when there is a chance of contracting a virus?
In the later case, the immune system would not be as strong as it could be when
trying to fight off the virus.
Eustice, Carol. "Flu Shot - Should People With
Rheumatoid Arthritis or Other Rheumatic Diseases Get a Flu Shot?." Arthritis and Joint Conditions - About.com.
About.com, 14 Oct. 2009. Web. 18 Oct. 2012.
<http://arthritis.about.com/od/arthqa/f/flushots.htm>.
"What is Enbrel® (etanercept)?." Moderate to Severe Plaque Psoriasis and
Rheumatoid Arthritis Treatment - Enbrel® (etanercept). Enbrel etanercept,
n.d. Web. 18 Oct. 2012. <http://www.enbrel.com/what-is-ENBREL.jspx?WT.z_co=P&WT.z_in=OTH&WT.z_ch=PDS&WT.z_se=G&WT.srch=1&WT.z_ag=enbrel&WT.mc_id=P_OTH_PDS_G_enbrel>.
I really liked this blog because it is a little different then we are used to. Personally, I think that whether or not a person completely stopped their Arthritis medication to get a vaccine would depend on how severe and progressive their particular form on arthritis was. With this said, we have to think about when someone would be taking medication. I would think that the point at which someone NEEDS a medication to do daily tasks or to alleviate pain associated with arthritis would be the time when they decided to not get a flu shot. overall, I think that most individuals wouldn't take the risk of going off their medication.
ReplyDeleteThis is really interesting. Come to think of it, If a person stopped taking his/her immunosuppressor for few months and received the vaccine and then continued their medication, is the vaccine going to help the immune system to response fully to be able to get rid of the flu infection later on? I would think the vaccine wouldn’t be too beneficial after the patients started taking their medication again because the immunosuppressor can suppress immune response. However, It makes more sense to stop taking immunosuppressor after the patient is already infected and is taking medication that will help him/her get rid of the flu.
ReplyDeleteMy friend who takes Enbrel for RA is careful not to receive live attenuated vaccines, but has never had a problem with inactivated vaccines. When she comes down with a cold she often stops taking her Enbrel because she feels like it speeds up her recovery. Just to put it into perspective, the elimination half-life of Enbrel in women is about 96 hours. A patient at "steady-state" (the concentration where absorption and elimination are in equilibrium) who stops taking their medication will have 1/3 the amount of Enbrel in their blood plasma after a week than they had at steady state. My point is that this drug stays in the system for a relatively long time, so even if you stop taking it for awhile it still might be doing its job (I don't know what the minimum effective amount of drug is but I read a blog where patients felt improvement after their first dose). Either way, I imagine that the severity of the illness would influence the decision to stop taking Enbrel. I am curious what most Rhuematologists recommend.
ReplyDeleteShe has received an inactive flu vaccine this season, and she received her MMR, before she was on any treatment. The only vaccines she would ever need that are live attenuated and not offered in inactivated form are Shingles and Yellow Fever (CDC website). Since there are no cases of Yellow Fever in the US and it is rare even with people traveling in endemic areas(CDC website), that is not going to be problem. My guess is she will just take her chances with Shingles.
Your question becomes most relevant if a new HIV, or Hepatitis C vaccine comes out that is only offered in the live, attenuated form. Hopefully they can all be made available in the inactive form even if it isn't as effective.
Pharmacokinetics of Etanercept:
Lee H, Kimko HC, Rogge M, Wang D, Nestorov I, Peck CC. Population pharmacokinetic and pharmacodynamic modeling of etanercept using logistic regression analysis. Clin Pharmacol Ther. 2003;73(4):348-65.
This blog was very interesting to me cause it left me thinking for a little bit. This is a hard choice people choosing treatment plans have to face. Everything in life has pros and cons, but when it comes to ones health and ones immune system it is really hard to weigh out the pros and cons. No matter what you chose to do, there will always be a con that can affect your daily routine or your lifestyle. Dealing with the flu seems like a better option to me than laying off the medication that will later cause RA. It is possible to take necessary safety precautions during flu season the lessen your chances of getting the flu such as not touching your face and washing your hands often. Laying off the medication that can prevent large progression of the RA, even for a few months just doesn't seem very appealing to me. Arthritis is not a disease I would want to mess with. If I could slow down its progression in any way, I definitely would.
ReplyDeleteThis is a very neat dilemma. It seems almost counterintuitive to boost your immune response by vaccination, when you have prescribed drugs of suppress that same immune system for another pathology. I think that vaccination itself presents increased risks in an immunosuppressed person. Especially, with live agent vaccination where a normal immune system would easily prevent disease condition, a suppressed immune system might not be able to and therefore lead to the disease that you were trying to prevent. In this case, you infected the person rather than immunized. Therefore, I think that arthritis would present a bigger issue and the medication should be continued while taking measures to prevent influenza infection (ie sterile room or bubble, well maybe not that extreme). Furthermore, the effects of arthritis damage would be more permenant and chronic than an influenza infection which would be fought off if the immune system is somewhat strong, so not completely suppressed.
ReplyDeleteThis is really interesting topic, as one of my friend is traveling outside the country soon and she has Rheumatoid Arthritis and has been taking the immunosupression drugs for a long time, it made me wonder if she should take a travelvaccine or not. As Muhammad mention that, "vaccination itself presents increased risks in an immunosuppressed person".
ReplyDeleteI did little research on it and found a article called vaccine advise which mentionedvthat live vaccine should be never given to the patient who are on immunosupression, mostly non-live vaccine are given. If you really need to get a vaccine, you have to stop taking immunosupression drug for 3 month and then get the vaccine. If you haven't started taking the drug yet, you should wait 2 to 4 weeks after vaccination to start taking the immunosupression drug. But as Dianna mentioned there is always going to be dilemma.