But if you are taking immune-suppressing medications for your psoriasis, you may benefit from getting an extra dose — or two — of the COVID-19 vaccine. How do you know if you qualify, and what else do you need to consider? The answer will depend on your current treatment regimen and which vaccine you got originally, as well as your age and overall health. To help you sort through some of the booster shot confusion, we’ve broken down the most recent recommendations from the Centers for Disease Control and Prevention (CDC) and the National Psoriasis Foundation (NPF), and offer insights from two leading psoriasis experts. RELATED: Coronavirus Alert: The Latest News, Data, and Expert Insight on the COVID-19 Pandemic That means if you got your second dose of the COVID-19 vaccine from Pfizer-BioNTech or Moderna six or more months ago, you are eligible for a booster shot. If you are age 50 or older, or you live in a long-term care setting, a booster shot is recommended. Because the CDC permits a “mix and match” approach to boosters, you can choose any vaccine brand for your third shot. If you opt for Moderna, you will get a half dose. People who take psoriasis medications that moderately or severely compromise their immune systems may consider following a separate set of CDC guidelines, states the NPF. This includes psoriasis patients who are both (a) taking injectable biologic medications, abatacept, cyclosporine, leflunomide, glucocorticoids (such as prednisone), methotrexate, or tofacitinib, and (b) have underlying conditions that increase their risk of severe COVID-19. If you fit these criteria, you are eligible to get a third shot as soon as 28 days after your second shot, and should stick with the same brand as your initial two-dose vaccine. Whether that’s Pfizer or Moderna, your third shot should be a full dose. This third shot is technically not considered a “booster,” but rather a part of your primary vaccination series. It’s meant to raise your immunity level to what’s seen in people with fully functioning immune systems after two doses, says the CDC. Even after receiving an extra shot, you’ll need to continue taking extra precautions to avoid exposure to COVID-19, such as wearing a mask (especially inside) and avoiding crowds. To reduce your odds of exposure, it’s also important that your family members and other close contacts get vaccinated, and also get their boosters when they are eligible. Six months after your third dose, you can get a booster — or fourth dose — to address waning immunity, says the CDC. For your fourth jab, you can choose any brand (Moderna will be a half-dose).
What if I Got the Johnson & Johnson Vaccine?
If you have psoriasis and received a single dose of the Johnson & Johnson (J&J) COVID-19 vaccine, the NPF echoes CDC guidelines in recommending you get a second dose two or more months after your first dose. This second shot is considered a booster, meant to address waning immunity. For this shot, you can choose from any of the three vaccine brands (Moderna will be a half dose). According to the NPF, psoriasis patients who are most likely to benefit from this second shot include those who are:
Age 50 or olderTaking abatacept, cyclosporine, leflunomide, glucocorticoids (for example, prednisone), methotrexate, or tofacitinibHave underlying conditions that increase their risk of severe COVID-19Are at increased risk of COVID-19 because of their jobs
RELATED: Living With Psoriasis During the Pandemic Can Have a Side Effect: Chronic Guilt
Can I Just Go and Get an Extra Shot or Do I Need to Talk to My Doctor First?
“You should talk to the physician you see for psoriasis treatment to [get their input] and determine if you are on an immunosuppressive medication prior to getting a booster shot,” says Lisa Zaba, MD, PhD, a clinical associate professor of dermatology at Stanford University School of Medicine in Palo Alto, California. Your physician can then help you determine which CDC booster guidelines you should follow and determine the best timing for your additional dose or doses. You don’t need a prescription or a doctor’s note to get a third shot or a booster, but you should bring your vaccination card.
If I Take an Immunosuppressive Medication, Does That Mean the COVID-19 Vaccine Won’t Protect Me?
“Not necessarily,” says Joel Gelfand, MD, the cochair of the National Psoriasis Foundation and a professor of dermatology and epidemiology at the University of Pennsylvania Perelman School of Medicine in Philadelphia. “Of the treatments commonly used for psoriasis, only methotrexate has been found to result in modest reductions in antibody response to the mRNA [messenger RNA] vaccines [from Pfizer and Moderna]. And the clinical significance of this finding is not known.” Dr. Gelfand also notes that the U.S. Food and Drug Administration (FDA) authorized expanded use of two-dose Pfizer and Moderna vaccines [last August] on the basis of data from patients who received an organ transplant and, as a result, were significantly immunosuppressed. Research has shown that these patients were not able to mount a significant immune response to the initial two-dose vaccine and that a third dose could help increase the amount of protective antibodies in their blood. RELATED: Study Finds That People on Methotrexate Mount a Weaker Immune Response to a COVID-19 Vaccine
Should I Temporarily Go Off My Psoriasis Medication After I Get a Booster Shot?
It’s very important to talk to your doctor before making any changes in your psoriasis medication, says Gelfand. He notes that certain patients who are taking methotrexate with well-controlled disease may — in consultation with their doctors — consider pausing their medication for two weeks after getting a booster shot. While this approach may improve antibody response, it’s not known if it will result in any meaningful benefit in terms of the risk of contracting COVID-19 or developing severe disease, he says.
If I Went Off Medication for Previous Vaccine Doses, Do I Still Need to Get a Booster Shot?
Because the effects of pausing methotrexate after getting a COVID-19 vaccine aren’t yet known, people with psoriasis who paused their medication after their initial COVID-19 vaccine should still consider getting an additional or booster shot, says Dr. Zaba.
