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Covid-19 Primary Care Resources

DMARDs and the Covid vaccine

Guidance for vaccinating individuals on treatment with DMARDs

This information is sourced from ARMA, Versus Arthritis, Specialist Pharmacy Service (SPS) and The Green Book Chapter 14a

  • GPs may need to discuss with secondary care regarding the timing of the dose around the vaccine
  • Rituximab is known to reduce the effectiveness of seasonal flu jab so theoretically may reduce the efficacy of the Covid vaccine (for up to six months from last dose or while on maintenance)
  • There is no evidence to suggest how long after rituximab a patient should delay vaccination with a Covid-19 vaccine, but consensus suggests this should ideally be 4-8 weeks after rituximab. However, this may be dependent on the prevalence of Covid-19 and should be agreed as being acceptable with the patient
  • The benefit of delaying Rituximab depends on the severity of clinical condition and needs discussion with the specialist team
  • The ARMA has published guidance on how to time rituximab for those with milder disease
  • Ocreluzimab may be treated in a similar way to Rituximab in that it may be advisable to delay a first administration until two doses of vaccine have been received (with the shortest dose interval licensed) as effectiveness of the vaccine can be reduced by up to 50%
  • Alemtuzumab and Cladribine may reduce immune response to vaccines so three months should pass before receiving the vaccine

Written by Dr Carrie St John Wright

See also:





PHE: COVID-19: the green book, chapter 14a

Published: 16/04/2021


Versus Arthritis: Vaccines for COVID-19 – your questions answered

Published: 19/04/2021


NHS Specialist Pharmacy Service. Using Covid-19 vaccines in patients taking immunosuppressive medicines.

Published 22/01/2021. Last updated 27 January 2022