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Cassandra Calabrese, DO, examines immunopathogenesis, immunomodulation, COVID-19 vaccinations, and pre-exposure prophylaxis.
United Rheumatology’s annual Fall National Meeting, held on October 29 and 30, will feature rheumatologists from across the country to discuss the latest news and research in the industry. Rheumatology Network interviewed Cassandra Calabrese, DO, to examine immunopathogenesis, immunomodulation, COVID-19 vaccinations, the newly-approved additional dose, and pre-exposure prophylaxis. Calabrese is a United Rheumatology member and practicing physician at the Department of Rheumatic and Immunologic Disease, Department of Infectious Diseases, Cleveland Clinic.
Rheumatology Network: Regarding COVID-19, what are your views on vaccination versus infection as well as the idea of super immunity?
Cassandra Calabrese, DO: While natural infection does provide some degree of immunity, COVID vaccines are recommended for everyone ages 12 and up regardless of history of symptomatic or asymptomatic COVID-19.
RN: How does immunopathogenesis and immunomodulation affect patients with rheumatic disease during the pandemic?
CC: Rheumatic disease patients have been faced with many challenges throughout the pandemic, including increased risk of severe outcomes from COVID-19 from underlying rheumatic disease and immunosuppressive therapy, as well as the potential for reduced vaccine effectiveness from immunosuppressive medications. Rituximab and other medications that deplete B cells have been at the forefront of both challenges.
RN: Should patients with rheumatic disease be receiving monoclonal as pre-exposure prophylaxis?
CC: There are certain groups of rheumatic disease patients who should be strongly considered for pre-exposure prophylaxis, in particular patients on B cell depleting agents like Rituximab. This is the same group that should be referred as soon as possible for treatment with monoclonal antibodies if infected with SARS-CoV-2
RN: How do you feel about the supplementary booster shot for this immunocompromised patient population?
CC: I think the recommendation for a 3rd COVID-19 mRNA vaccine dose for immunocompromised patients is great. This is technically referred to as an “additional dose” rather than a booster.
RN: Can you tell me a bit about United Rheumatology and how the organization helps clinicians?
CC: United Rheumatology is the benefits management services organization that enables relationships with health plans and maximizes healthcare delivery by supporting private practices with day-to-day operational challenges so physicians can thrive in a dynamic healthcare environment.
RN: Is there anything else you’d like our audience to know?
CC: Continue to encourage the COVID-19 vaccine (and all recommended vaccines) for your patients. Have a discussion with your patients about what to do should they test positive or have concerns that they may have had a high-risk SARS-CoV-2 exposure, including having them inform you ASAP so they can be routed for monoclonal antibody treatment, if appropriate, as well as encouraging them to keep rapid COVID test kits at home.
For more information and to attend this event, visit United Rheumatology’s 2021 Fall National Meeting.