Third dose, those who take these drugs reported by Aifa should do it

The administration of the third dose, or better to say additional dose (we explained the difference between booster and additional dose here), it started a few days ago. All the Italian health authorities have established that it must be administered to immunocompromised people, transplant recipients and cancer patients. About three million people. Then it will be the turn of the over 80s, the guests of the residences for the elderly and the health workers of the Covid wards. For all the others, one will have to wait for the pronouncement of the EMA. Although surveys coming from Israel, where much of the most at-risk population over 60 has already received the third dose, say that the booster is essential and increases the antibody titer many times: the infection rate, one claims. study just published on New England Journal of Medicine, at least 12 days after administration is 11.3 times lower than the two doses while the severe disease rate is 19.5 times lower.

For a few hours theAifa, the Italian Medicines Agency, published a list of drugs with greater immunosuppressive or immunomodulatory activity: who takes them, except for other contraindications and after consultation with the doctors who follow him, should receive the additional vaccine dose. In short, the AIFA tries to facilitate the selection of subjects for whom another administration may be indicated (as required by the relative circular of the Ministry of Health of 14 September). “This list was drawn up on the basis of the mechanism of action of the different drugs, the literature available on the effects of these drugs on the antibody response in vaccinated patients, the recommendations made by scientific societies or international organizations and on the basis of a comparison with experts clinicians »reads the AIFA document. But be careful: the list is not exhaustive but “only indicative of the main drugs whose intake, at the same time or in the six months prior (where not specifically detailed) the administration of the previous doses of the vaccine, may have reduced the antibody response”.

In short, the list must be used ‘as part of a clinical evaluation that takes into account not only the drugs used, but also the specific diagnosis, clinical history and current status of the individual patient “. At that point, an additional dose of vaccine may also be recommended to patients treated with drugs not on the list (and obviously also to others who do not take any of those drugs but who belong to one of these ten priority categories of frailty). The document indicates further elements on timing: the timing of the administration of the additional dose for patients under treatment will have to take into account the type of medicine used for the treatment of specific underlying diseases, in order to ensure the best possible response to the vaccine. In any case, please note that the administration of the additional dose it cannot occur earlier than 28 days after the second vaccine dose. Finally, it is reiterated that the decision to administer an additional dose of vaccine must be made in relation to the clinical characteristics of the patient, not based on the anti-spike antibody dosage as a reference standard is not currently available and a concentration considered optimal / adequate has not been defined “. The serological testin short, it is of little use in this sense.

The list of drugs can be consulted at this link. You go by alkylating drugs (Melphalan, Treosulfan among others) ai antimetabolites passing through the alkaloids, i citotossici, the protein kinase inhibitors and other antineoplastic agents up to selective immunosuppressants, those of TNF-alpha, interleukins, calcineurin and other immunosuppressants. Aifa also lists corticosteroid drugs (the only class of drugs for which it is suggested to consider the dosage used as a criterion for deciding on the additional dose of vaccine), yes according to non-binding indications.