by
Haewon Lee;
Jennifer A. Punt;
David C. Miller;
Ameet Nagpal;
Clark C. Smith;
Yusef Sayeed;
Jaymin Patel;
Milan P. Stojanovic;
Adrian Popescu;
Zachary L. McCormick
MYTH: Corticosteroid injection for the treatment of pain and inflammation is known to decrease the efficacy of the messenger ribonucleic acid (mRNA) vaccines for coronavirus disease 2019 (COVID-19). FACT: There is currently no direct evidence to suggest that a corticosteroid injection before or after the administration of an mRNA COVID-19 vaccine decreases the efficacy of the vaccine.However, based on the known timeline of hypothalamic-pituitary-adrenal (HPA) axis suppression following epidural and intraarticular corticosteroid injections, and the timeline of the reported peak efficacy of the Pfizer-BioNTech and Moderna vaccines, physicians should consider timing an elective corticosteroid injection such that it is administered no less than 2 weeks prior to a COVID-19 mRNA vaccine dose and no less than 1 week following a COVID-19 mRNA vaccine dose, whenever possible.
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.
by
David C. Miller;
Jaymin Patel;
Jatinder Gill;
Ryan Mattie;
Mathew Saffarian;
Byron J. Schneider;
Adrian Popescu;
Vivek Babaria;
Zachary L. McCormick
Myth: Epidural and intra-articular steroid injections have no effect on the risk of contracting COVID-19 infection.
Fact: There is low-quality evidence that a single intra-articular corticosteroid injection may increase the risk of contracting the influenza virus. No study has yet been published that examines whether a corticosteroid injection increases the risk of contracting COVID-19 or alters the clinical course of a subsequent infection. While caution is advised based on this indirect evidence, more studies are needed to determine full correlation of corticosteroid administration and risks of contracting COVID-19.