Do Corticosteroid Injections for the Treatment of Pain Influence the Efficacy of mRNA COVID-19 Vaccines?

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; Spine Intervention Society’s Patient Safety Committee

doi:10.1093/pm/pnab063

Do Corticosteroid Injections for the Treatment of Pain Influence the Efficacy of mRNA COVID-19 Vaccines?

Pain Med. 2021 Apr 20;22(4):994-1000. doi: 10.1093/pm/pnab063.

Affiliations

¹ University of California, San Diego, Department of Orthopedic Surgery, San Diego, California, USA.
² University of Pennsylvania School of Veterinary Medicine, Philadelphia, Pennsylvania, USA.
³ Napa Pain Institute, Napa, California, USA.
⁴ Department of Anesthesiology, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA.
⁵ Columbia University Medical Center, Rehabilitation and Regenerative Medicine, New York, New York, USA.
⁶ Uniformed Services University of the Health Sciences, Department of Physical Medicine and Rehabilitation, Department of Family Medicine, Eglin AFB, Florida, USA.
⁷ Emory University, Department of Orthopedics, Atlanta, Georgia, USA.
⁸ Anesthesiology, Critical Care and Pain Medicine Service, VA Boston Healthcare System, Harvard Medical School, Boston, Massachusetts, USA.
⁹ Hospital of University of Pennsylvania, Department of Physical Medicine and Rehabilitation, Philadelphia, Pennsylvania, USA.
¹⁰ University of Utah, Division of Physical Medicine and Rehabilitation, Salt Lake City, Utah, USA.

Abstract

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.

MeSH terms

Adrenal Cortex Hormones / administration & dosage*
COVID-19 Vaccines / administration & dosage*
COVID-19*
Humans
Pain / drug therapy*
Time Factors
Vaccines, Synthetic / administration & dosage*
mRNA Vaccines

Substances

Adrenal Cortex Hormones
COVID-19 Vaccines
Vaccines, Synthetic