COVID-19 Vaccine and Behçet’s - updated 27/01/21

[TonyWT]

Please see the definitive Behçet’s Centres of Excellence position statement (December 2020) on COVID-19 vaccine via the attached link. It states "The three centres of excellence recommend the Pfizer/BioNTech Covid-19 Vaccine for patients with Behçets." and then gives the justification why. This includes those on immunosuppressants who should have the Pfizer/BioNTech Covid-19 Vaccine (and it is not a live vaccine).

The exception is for women who are pregnant who should not have the vaccine since, as stated elsewhere nationally, there is currently insufficient research evidence to make a positive recommendation.

behcets.nhs.uk

Notwithstanding the aforesaid, for those not treated at one of the three Centres of Excellence in England it is advised to always consult your treating clinician for specific advice for ‘yourself’; and Behçet's UK is not allowed (qualified) to offer clinical advice. However, it may well be that your treating clinician is not as extensively informed about Behçet's as is available in one of the multi-disciplinary centres; understandably/inevitably. You could therefore suggest that he or she consult with one of the three Clinical Directors at the Centres of Excellence.

Furthermore, each vaccine will be judged independently when they become available – particularly applicable to some Behçet's patients (and by no means that many) who can have a bad reaction to vaccine. A Governmental statement on Oxford/AstraZeneca Covid-19 vaccine can be found via this link: gov.uk/government/publicati...].

As to efficacy (effectiveness), fundamentally, [“ ”medical note sent to Behçet's UK]

“… one of the unknowns is that an immunocompromised person, including individuals receiving immunosuppressant therapy, may have a diminished immune response to the vaccine. Detailed information is not yet available. As a general principle, patients should not stop their immunosuppression”.

This ‘immune response’ is precisely what the vaccine is trying to encourage to help protect you, and evidence will be accumulated very rapidly on this issue as the vaccine is administered on a massive scale.

“Cautions are the same for Behçet’s patients as per the general population e.g. patients who have a history of immediate-onset anaphylaxis to a vaccine, medicine or food should not receive the Pfizer/BionTech COVID-19 mRNA Vaccine BNT162b2, do not administer in individuals suffering from an acute severe febrile illness.”

There are specific considerations regarding the use of rituximab and it is recommended that anyone on this (and is not being treated at one of the Centres of Excellence in England) should have their treating clinician speak with Professor Robert Moots at the Liverpool Centre of Excellence. [e-mail]

Basically, it is to do with ‘timing’.

“If a patient needs to start a new DMARD/biologic but has not been vaccinated, it may be appropriate to consider selecting an alternative DMARD / biologic medication to rituximab, if available and appropriate, e.g. in patients with rheumatoid arthritis.”

Conclusion

I trust this helps clarify the logic behind what is being recommended and alleviate any concerns/stress that individuals may, understandably, have at this time. As we know, stress is never a good thing for those with Behçet’s.

As mentioned previously, if your own treating clinician/GP is not an ‘expert’ in Behçet’s, you could suggest that they may wish to "seek a second opinion from a specialist at one of the CoE, who are studying/monitoring the issues in detail" - and they support hundreds of patients, so they have the clinical evidence. This conforms to General Medical Council - Good medical practice: "The duties of a doctor registered with the General Medical Council - Recognise and work within the limits of your competence".

Tony

[Juliauk10]

Thank you so much Tony 🤗