One of my high school classmates, Chester Lee, sent me a link to an article on Medpage Today that everyone who is immunosuppressed should read.

The article, COVID Vax in the Immunosuppressed: Reason for Concern, summarizes a report from a team of transplant surgeons at Johns Hopkins that was just published in the Journal of the American Medical Association (JAMA.)

The Medpage today article by Dr. Dorry Segev addresses an issue that has been on my mind ever since Covid-19, SARS-CoV2, or the Coronavirus (take your pick; this disease has more names than the Four Horsemen of the Apocalypse) first struck: how will such a virulent virus affect immunosuppressed people? More importantly, how will immunosuppression regimens affect the vaccines that were being developed to treat this new plague.

It didn’t take epidemiologist long to realize that this plague attacks people with suppressed immune systems with a vengeance, putting a higher percentage of them into intensive care than other patients without such underlying conditions, and killing them with greater frequency than the general population. The firefighters on the front lines of this medical apocalypse figured that out right quick, but it has taken exactly one year to get a definitive statement about how immunosuppressant regimens will affect the efficaciousness of the vaccines we are now receiving to combat the virus…and the news is not good.

The first number that jumps out from the report suggests that  only 17% of the immunosuppressed patients, all of whom were solid organ transplant recipients, developed antibodies, as opposed to 100% of the members of the general (non-immunosuppressed) population.  The survey only studied Pfizer and Moderna recipients.

The second number indicates that patients receiving anti-metabolic therapies such as mycophenolate or azathioprine were five times less likely to develop the antibodies the vaccines are designed to create, with 8.75% of of the anti-metabolic patients showing antibodies versus 41.4% in the general population.

This report was interested me because, at this time last year, I was taking methotrexate, an immunosuppressant drug,  to combat psoriasis and psoriatic arthritis.

Methotrexate is an unusual drug. It is really cheap, because it is an older drug, so it is widely prescribed as an immunosuppressant for the treatment of certain cancers, but it has also been accused of causing other cancers.

Taking Medicine into Your Own Hands

Over the past 12 months, we have seen medical professionals assuming the dignity of war heroes, with good reason. They have been on the front lines in the battle against Covid-19 from the get-go, but that doesn’t mean that all medical professionals are equally trustworthy, and that goes double in Florida. Often, even with managed care systems, it is necessary to take your care into your own hands, with good reason.

There is too much information pouring out of from a wide-variety of unvetted resources, generating misconceptions, confusion and sometime intention disinformation. Doctors are just as susceptible to this data corruption as everyone else is. We all form our opinions on a hodgepodge of resources and, in an environment where even leading scientific journals are regularly gamed by their own contributors, you really can’t take anything at face value, including this article. Everyone is subject to the same overloaded media environment.

In my case, I was taking methotrexate, an immunosuppressant, for psoriatic arthritis and psoriasis and, purely on instinct, I stopped taking the methotrexate-folic acid cocktail when the epidemic hit on the grounds that impairing my immune system to combat a non-lethal condition did not make sense with respect to the threat from a potentially lethal condition.  I had the option to discontinue that drug regimen because I didn’t have to worry about organ rejection. Psoriasis and psoriatic arthritis are conditions caused by an over-active immune system, something borne out by the fact that I almost never get sick. My blanket immunity increased in direct proportion to the psoriatic activity of my body.

I remain amazed, however, that I was able to figure this out and yet this Medpage Today article is the first piece of evidence indicating whether it was smart (or stupid) to discontinue non-essential immunosuppressant therapies. I never heard any such cautions from any of my physicians, all of whom obviously know that I was taking methotrexate.

The Immunosuppressant Drugs

The Patient.Info website lists the following drugs as the major immunosuppressants:

These drugs are often prescribed for Cancers such as lymphoma or leukaemia, Rheumatoid arthritis, Crohn’s disease, Ulcerative colitis,  psoriasis and psoriatic arthritis.

If you are an organ transplant recipient, you obviously know that you are on immunosuppressants, but these drugs also have other uses, including some off-label applications, so if you are taking any of these drugs, you should probably talk to your doctors about the implications for the success of your vaccinations.  If you are not a transplant patient, but you are taking any of these drugs, you might want to have the same conversation.

I am not trying to practice medicine without a license, but the medical profession has been practicing on me for the the past twenty year. Turnabout is fair play.