Steroid injections in pain management: influence on coronavirus disease 2019 vaccines
2
조회
0
다운로드
1
인용
0
참고문헌
키워드
초록
The coronavirus disease 2019 (COVID-19) pandemic, which has been rampant since the end of 2019, has evidently affected pain management in clinical practice. Fortunately, a COVID-19 vaccination program is currently in progress worldwide. There is an ongoing discussion that pain management using steroid injections can decrease COVID-19 vaccine efficacy, although currently there is no direct evidence to support this statement. As such, the feeling of pain in patients is doubled in addition to the co-existing ill-effects of social isolation associated with the pandemic. Thus, in the COVID-19 era, it has become necessary that physicians be able to provide high quality pain management without negatively impacting COVID-19 vaccine efficacy. Steroids can alter the entire process involved in the generation of adaptive immunity after vaccination. The period of hypophysis-pituitary-adrenal axis suppression is known to be 1 to 4 weeks after steroid injection, and although the exact timing for peak efficacy of COVID-19 vaccines is slightly different for each vaccine, the average is approximately 2 weeks. It is suggested to avoid steroid injections for a total of 4 weeks (1 week before and after the two vaccine doses) for the doubleshot vaccines, and for 2 weeks in total (1 week before and after vaccination) for a single-shot vaccine. This review focuses on the basic concepts of the various COVID- 19 vaccines, the effect of steroid injections on vaccine efficacy, and suggestions regarding an appropriate interval between the administration of steroid injections and the COVID-19 vaccine.
Abstract
The coronavirus disease 2019 (COVID-19) pandemic, which has been rampant since the end of 2019, has evidently affected pain management in clinical practice. Fortunately, a COVID-19 vaccination program is currently in progress worldwide. There is an ongoing discussion that pain management using steroid injections can decrease COVID-19 vaccine efficacy, although currently there is no direct evidence to support this statement. As such, the feeling of pain in patients is doubled in addition to the co-existing ill-effects of social isolation associated with the pandemic. Thus, in the COVID-19 era, it has become necessary that physicians be able to provide high quality pain management without negatively impacting COVID-19 vaccine efficacy. Steroids can alter the entire process involved in the generation of adaptive immunity after vaccination. The period of hypophysis-pituitary-adrenal axis suppression is known to be 1 to 4 weeks after steroid injection, and although the exact timing for peak efficacy of COVID-19 vaccines is slightly different for each vaccine, the average is approximately 2 weeks. It is suggested to avoid steroid injections for a total of 4 weeks (1 week before and after the two vaccine doses) for the doubleshot vaccines, and for 2 weeks in total (1 week before and after vaccination) for a single-shot vaccine. This review focuses on the basic concepts of the various COVID- 19 vaccines, the effect of steroid injections on vaccine efficacy, and suggestions regarding an appropriate interval between the administration of steroid injections and the COVID-19 vaccine.
참고문헌 (36)
- "WHO Corona virus (COVID-19)dashboard" (2021)[URL]
- "Information of Corona virus (COVID-19) vaccines in Korea" (2021)[URL]
- Tregoning JS, "Vaccines for COVID-19", Clin Exp Immunol, 202, pp.162~192 (2020)
- Nagy A, "An overview of current COVID-19 vaccine platforms", Comput Struct Biotechnol J, 19, pp.2508~2517 (2021)
- 유진홍, "What We Do Know and Do Not Yet Know about COVID-19 Vaccines as of the Beginning of the Year 2021", Journal of Korean Medical Science, 36(6), pp.1~17 (2021), 대한의학회[DOI]
- Lipsitch M, "Interpreting vaccine efficacy trial results for infection and transmission", Vaccine, 39, pp.4082~4088 (2021)
- Polack FP, "Safety and efficacy of the BNT162b2 mRNA Covid-19 vaccine", N Engl J Med, 383, pp.2603~2615 (2020)
- Lee H, "Do corticosteroid injections for the treatment of pain influence the efficacy of mRNA COVID-19 vaccines?", Pain Med, 22, pp.994~1000 (2021)
- Strehl C, "Glucocorticoids-allrounders tackling the versatile players of the immune system", Front Immunol, 10, pp.1744~ (2019)
- Akondy RS, "Origin and differentiation of human memory CD8T cells after vaccination", Nature, 552, pp.362~367 (2017)
- Lindgren G, "Induction of robust B cell responses after influenza mRNA vaccination is accompanied by circulating hemagglutinin-specific ICOS+ PD-1+ CXCR3+ T follicular helper cells", Front Immunol, 8, pp.1539~ (2017)
- Hartley GE, "Rapid generation of durable B cell memory to SARS-CoV-2 spike and nucleocapsid proteins in COVID-19and convalescence", Sci Immunol, 5, pp.eabf8891~ (2020)
- Ingawale DK, "New insights into the novel antiinflammatory mode of action of glucocorticoids", Immunopharmacol Immunotoxicol, 42, pp.59~73 (2020)
- Kubiet MA, "Serum antibody response to influenza vaccine in pulmonary patients receiving corticosteroids", Chest, 110, pp.367~370 (1996)
- Herron A, "Influenza vaccination in patients with rheumatic diseases. Safety and efficacy", JAMA, 242, pp.53~56 (1979)
- Coutinho AE, "The anti-inflammatory and immunosuppressive effects of glucocorticoids, recent developments and mechanistic insights", Mol Cell Endocrinol, 335, pp.2~13 (2011)
- "General best practice guidelines for immunization. Best practices guidance of the Advisory Committee on Immunization Practices (ACIP)" (2021)[URL]
- Fischer L, "Pneumococcal polysaccharide vaccination in adults undergoing immunosuppressive treatment for inflammatory diseases--a longitudinal study", Arthritis Res Ther, 17, pp.151~ (2015)
- Yıldız N, "Hepatitis B virus vaccination in children with steroid sensitive nephrotic syndrome: immunogenicity and safety?", Vaccine, 31, pp.3309~3312 (2013)
- Hottinger AF, "A prospective study of the factors shaping antibody responses to the AS03-adjuvanted influenza A", H1N1vaccine in cancer outpatients, 2012, pp.17, 436~445
- Vormehr M, "Dexamethasone premedication suppresses vaccineinduced immune responses against cancer", Oncoimmunology, 9, pp.1758004~ (2020)
- Stout A, "Systemic absorption and side effects of locally injected glucocorticoids", PM R, 11, pp.409~419 (2019)
- Woo Young Kang, "Systemic effects of fluoroscopically guided epidural steroid injection with dexamethasone", The Korean Journal of Pain, 32(3), pp.178~186 (2019), 대한통증학회[DOI]
- Chucair-Elliott AJ, "Long-term consequences of topical dexamethasone treatment during acute corneal HSV-1 infection on the immune system", J Leukoc Biol, 101, pp.1253~1261 (2017)
- Sytsma TT, "Joint corticosteroid injection associated with increased influenza risk", Mayo Clin Proc Innov Qual Outcomes, 2, pp.194~198 (2018)
- Habib GS, "Systemic effects of intra-articular corticosteroids", Clin Rheumatol, 28, pp.749~756 (2009)
- Miller DC, "Corticosteroid injections and COVID-19 infection risk", Pain Med, 21, pp.1703~1706 (2020)
- Weitoft T, "Glucocorticoid resorption and influence on the hypothalamic-pituitary-adrenal axis after intra-articular treatment of the knee in resting and mobile patients", Ann Rheum Dis, 65, pp.955~957 (2006)
- Abdul AJ, "Hypothalamic pituitary adrenocortical axis suppression following a single epidural injection of methylprednisolone acetate", Pain Physician, 20, pp.E991~E1001 (2017)
- Iranmanesh A, "Hypothalamo-pituitary-adrenal axis after a single epidural triamcinolone injection", Endocrine, 57, pp.308~313 (2017)
- Brill S, "Neuro-axial steroid injection in pain management and COVID-19 vaccine", Eur J Pain, 25, pp.945~946 (2021)
- Chakravarthy K, "Recommendations and guidance for steroid injection therapy and COVID-19 vaccine administration from the American Society of Pain and Neuroscience(ASPN)", J Pain Res, 14, pp.623~629 (2021)
- Friedly JL, "Systemic effects of epidural steroid injections for spinal stenosis", Pain, 159, pp.876~883 (2018)
- Hasan SS, "Use of corticosteroids in asthma and COPD patients with or without COVID-19", Respir Med, 170, pp.106045~ (2020)
- "General guidelines for the management of patients with pain during the COVID-19 global pandemic era" (2021)[URL]
- Gharibo C, "Triaging interventional pain procedures during COVID-19 or related elective surgery restrictions : evidenceinformed guidance from the American Society of Interventional Pain Physicians(ASIPP)", Pain Physician, 23(4S), pp.S183~S204 (2020)