What recommendations and cautions should be adopted when vaccinating cohorts of ophthalmic patients who, due to pathology or therapy, have problems with their autoimmune profile.
The COVID-19 epidemic has disrupted the lives of people all over the world, now causing millions of deaths, and vaccination to immunise against the Sars-Cov-2 virus is currently the only way to bring our communities back to normal standards of activity and social interaction.
What, however, are the recommendations and precautions to be taken in the case of patients with inflammatory eye diseases and/or autoimmune diseases? A recently published research study is dedicated to this interesting topic.
Ophthalmological Considerations for COVID-19 Vaccination in Patients with Inflammatory Eye Diseases and Autoimmune Disorders.
Chau, C.Y.C., Chow, L.L.W., Sridhar, S. et al.
Ophthalmol Ther (2021).
Unfortunately, very limited data are available on the administration of anti-Covid vaccines to patients with inflammatory or immunosuppressed eye diseases, largely due to the specific trial model that had to be adopted. Typically, vaccine development times are in the order of 10-15 years, but the pandemic emergency imposed a new clinical trial model, with flexible platforms, characterised by an accelerated time-line, with clinical phases carried out in combination or partially overlapping. Hence the lack of pharmacovigilance studies and specific guidelines for sub-populations of patients.
I pharmacologically immunosuppressed patients constitute a significant group of vulnerable patients of delicate management for ophthalmologists during a pandemic. If immunosuppressive therapy or immunomodulatory treatments, necessary to control inflammation, can become a cause of comorbidities and make vaccine administration problematic, reducing or discontinuing them can induce recurrences of the treated ocular disease, with serious consequences in terms of impaired visual function and quality of life, as has been observed in patients suffering from uveitissince the beginning of the pandemic.
There are, therefore, two main issues to be addressed:
1. The relationship between the immunosuppressed system and the outcomes of SARS-Cov-2 infection. It could be assumed that immunosuppressed individuals are at greater risk of infection. However, there is clinical evidence that immunocompromised patients (such as HIV patients or organ transplant recipients) generally have asymptomatic or mild Covid. Immunosuppression could, therefore, attenuate the hyper-inflammation that in Covid-19 is the main driver of organ damage. On the other hand, it cannot be neglected that the attenuation of antimicrobial immunity may increase viral load and inflammation, thus the severity of Sars-Cov-2 disease.
2. The suppressed immune system can also compromise theimmunogenicity of the vaccinei.e. its ability to promote antibody reaction.
Regarding the timing of vaccinations, most studies on patients with autoimmune-based inflammatory rheumatic diseases have been conducted on patients in the quiescent stage, so data are still lacking for those with active disease in a moderate or severe form.
For optimal vaccination timing, doctors and ophthalmologists should also be aware of the possibility of ADE (Antibody-Dependent Enhancement)i.e. antibody-dependent enhancement due to pre-existing eye diseases of an inflammatory nature.
These complex aspects of patient assessment can be explored in the full text of the research accessible through this link.
Good reading
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Dr. Carmelo Chines
Direttore responsabile
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