CMAAO Coronavirus Facts and Myth Buster - Steroids and Vaccine
Dr KK Aggarwal, 30 April 2021
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With input from Dr Monica Vasudev
- There appears to be no direct evidence to state that corticosteroid injection prior to or after an adenovirus vector-based COVID-19 vaccine diminishes vaccine efficacy. Yet, clinicians may want to give elective corticosteroid injections at least two weeks before or after receiving this vaccine, reported a group of doctors writing on behalf of the Spine Intervention Society.
- The two-week rule is based on the known timeline of hypothalamic-pituitary-adrenal (HPA) axis suppression after intraarticular and epidural corticosteroid injections, noted researchers in a paper published in Pain Medicine.
- The two week rule is also based on the timeline of reported peak efficacy of the Janssen and AstraZeneca adenovirus-vector-based vaccines against COVID-19.
- An interim analysis of phase 1-2a and phase 3 trial data revealed that the Janssen COVID-19 vaccine elicited cellular and humoral immune responses and conferred clinical protection as early as 14 days following administration, while the AstraZeneca vaccine elicited response 15 days following the second dose.
- The Janssen phase 3 trial allowed corticosteroid use at or below the equivalent of 20mg/day through ocular, topical or inhaled administration
- Topical or inhaled steroids were allowed in the AstraZeneca trial for up to 14 days.
[Source: https://bit.ly/3gFPHAl Pain Medicine, online April 11, 2021.]
Dr KK Aggarwal
President CMAAO, HCFI and Past National President IMA
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