Do Corticosteroid Injections for the Treatment of Pain Influence the Efficacy of Adenovirus Vector-Based COVID-19 Vaccines?

• Type of Material: Article
• Authors: Haewon Lee, University of California San Diego; Jennifer A. Punt, University of Pennsylvania; Jaymin Patel, Emory University; Milan P. Stojanovic, Harvard Medical School; Belinda Duszynski, Spine Intervention Society; Zachary L. McCormick, University of Utah
• Language: English
• Date: 2021-06-01
• Publisher: OXFORD UNIV PRESS
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © The Author(s) 2021. Published by Oxford University Press on behalf of the American Academy of Pain Medicine.
• Final Published Version (URL): http://dx.doi.org/10.1093/pm/pnab130
• Title of Journal or Parent Work: PAIN MEDICINE
• Volume: 22
• Issue: 6
• Start Page: 1441
• End Page: 1444
• Grant/Funding Information: No funding was received in preparation of this manuscript.
• Keywords: PITUITARY-ADRENAL AXIS; KNEE; Medicine, General & Internal; General & Internal Medicine; Science & Technology; Anesthesiology; Life Sciences & Biomedicine
• Research Categories: Health Sciences, Medicine and Surgery

Abstract

MYTH: Corticosteroid injection for the treatment of pain is known to decrease the efficacy of the adenovirus vector-based vaccines for COVID-19. FACT: There is currently no direct evidence to suggest that a corticosteroid injection before or after the administration of an adenovirus vector-based COVID-19 vaccine decreases the efficacy of the vaccine. However, based on the known timeline of hypothalamic-pituitary-adrenal axis suppression following epidural and intraarticular corticosteroid injections, and the timeline of the reported peak efficacy of the Janssen and AstraZeneca vaccines, physicians should consider timing an elective corticosteroid injection such that it is administered no less than 2 weeks prior to and no less than 2 weeks following a COVID-19 adenovirus vector-based vaccine dose, whenever possible. We emphasize the importance of risk/benefit analysis and shared decision making in determining the timing of corticosteroid injections for pain indications in relation to receipt of a COVID-19 vaccine given that patient-specific factors will vary.