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Orencia, CV vaccine and antibody levels?

With this big spike happening now with the Delta variant that is infecting vaccinated people, what do we know about Orencia and how Orencia might blunt the vaccine response? I googled this question and best I could find is this recent study out of Washington that has not yet been peer reviewed, but it is looking like methotrexate, TNF and some DMARDS might reduce vaccine effectiveness by a factor of 3. On other end of spectrum B cell depleting agents like Rituximab reduced vaccine effectiveness by 36 fold, yikes! Just wondering if it is time to cancel upcoming plans, go on leave from work and hole up again?

https://www.medrxiv.org/content/10.1101/2021.04.05.21254656v2#disqus_thread


  1. The scientific name of Orencia is abatacept. As you look at the next two references, they will identify Orencia by the scientific name.


    There are at present three statements from ACR regarding the Covid-19 vaccination and the use of biologic medications used for RA, in particular, and rheumatology in general.


    Two of these statements are available, and the third is yet to be published on August 3, 2021.


    Here are the two most recent statements. One is a smaller restatement of the first one.


    The full text is:


    https://onlinelibrary.wiley.com/doi/full/10.1002/art.41877


    and the second is


    https://www.rheumatology.org/Portals/0/Files/COVID-19-Vaccine-Clinical-Guidance-Rheumatic-Diseases-Summary.pdf


    Generally speaking, the issues involve the timing of the medication in relation to the timing of the vaccine. Of course, you should speak to your rheumatologist about this matter before taking any course of action.

    1. Thank you! I will read your links and see what they have figured out. I questioned the timing of vaccine and orencia. I asked my rheumatologist this very question as if I have to hold orencia 2 weeks before and after a surgery or when sick, it makes sense to hold it back prior to and after getting a covid vaccine, She had no answer as there is is no real data and said do what felt best for me. I choose to hold back 2 weeks prior and a week after both my pfizer shots.


      I think the problem is once a medication is FDA approved, then no more incentive for a drug manufacture to spend time of money to do research to see how it interacts with other medications or this vaccine. I am going to look into an antibody test and jump on first chance for a booster shot.


      1. There is a tremendous amount of research ongoing that is attempting to answer these questions. I just spent an hour listening leading edge researchers who said they feel there is little published papers about these questions. All agreed that this is a major focus of research and papers in process. I know it cannot come quickly enough. I hope so.


        rick

    2. Thanks Rick! I know there are many of us out there wondering if the vaccine is working or not, pretty scary really with the new variants happening and infection spreading rapidly. I did get a call back from a nice gal from Bristol Myers Squid that makes Orencia/Abatacept. She was likely a customer service type employee and really had to answers to my questions other than follow the CDC recommendations of the last year, pretty much same as my Rheumy doc.


      All this seems like a big red flag for the free enterprise system we have when it comes to medical care and medications in the US. Once these drug manufactures get through the long process of FDA approval, then they wash their hands of any future research on interaction, side effects, or now pandemic issues with a fast moving virus mutating as I type. We have to rely of poorly funded universities to get grant funding to figure out these complicated questions and meanwhile people like me feel like a human Guinee pig with my life at stake if I do not work hard to be overly protective to avoid CV infection. I hope others on these powerful immunosuppressants take caution and avoid potential infectious situations by having other help shop and do all the things we know work, ie, masking and social distancing. I do hope someone with a brain will see the results of some of this early research and help open up boosters for us at risk. Maybe I gotta write Dr Fauci, he might care.

      1. I definitely understand what you're saying. It's difficult as you put it to feel like a human guinea pig. It sounds though like you're doing everything you can do - including speaking with doctors, doing your research, and making decisions that are best for you. I do know it's hard. Thanks for your thoughts on this. - Reggie, RheumatoidArthritis.net Team Member

    3. Thanks for your consideration. I was able to find just a few recent studies, I do not have them here now to footnote. But in case others are interested and do same as I did, you will find out that during the initial testing for the CV vaccines people with RA and on meds were excluded. I question if there was some concern there might be some issues that might result in lower vaccine effectiveness(?).


      With so many people on immunosuppressants and DMARDS, maybe they could have had some subgroups of people on other meds, so we might actually have some data to work with for this vaccine to better understand the interactions with other meds.


      But the recent studies I did find, are showing results of people on DMARDS like methotrexate and people on TNF meds have 3 times reduction in vaccine effectiveness, people on daily prednisone greater than 20 mg and Orencia/Abatacept have a 10 times reduction in vaccine effectiveness and those on Rituxan have a 36 times reduction in effectiveness. Again, small studies, so who really knows (?). And other studies found out people with RA were more likely than others to be hit harder by CV and have higher rates of hospitalization, death and other comorbidities.


      These are very preliminary studies based on low number of people studied and one study looked like it was a poll of rheumatologist opinions of their thoughts on this subject, so who knows where we will be a year or more from now after more studies come out. And factor in the virus is a "cat-mouse" game that is changing as it mutates in response to human behavior and human immune systems and things we may not understand yet.



      I am just a gal with RA with a background in biological science, not a doc or researcher, so maybe if other people with RA have similar questions about how the pandemic and vaccines may impact them, they should do some homework like I did and talk with your doc, do some internet snooping and call the drug manufactures. But all this tells me to be even more cautious. Last night I was able to order some affordable 3m N95 masks as I think I need better protection than a simple mask when out and about.

      1. , thanks for sharing what you have learned! We are definitely living in strange times and it's quite hard to wade through all the information coming at us 24/7! I think you have very valid questions and concerns!


        Best, Erin, RheumatoidArthritis.net Team Member.

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