With input from Dr Monica Vasudev

1. 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.
2. 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.
3. 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.
4. 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.
5. The Janssen phase 3 trial allowed corticosteroid use at or below the equivalent of 20mg/day through ocular, topical or inhaled administration
6. 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