Spine Intervention Society Publishes Recommendations on Corticosteroid Timing and COVID-19 Vaccine Efficacy

Anesthesiologist do spinal nerve block for patient before surgery.
The Spine Intervention Society sets out to separate myths from facts about the effect of corticosteroid injections on the efficacy of vaccines for COVID-19.

Although no evidence links corticosteroid injections with decreased efficacy of the currently authorized COVID-19 vaccines, the Spine Intervention Society’s Patient Safety Committee recommends clinicians consider timing a corticosteroid injection for pain treatment ≥2 weeks before or ≥2 weeks after administering a COVID-19 adenovirus vector-based vaccine. This recommendation was published in the journal Pain Medicine.

In its article, the Spine Intervention Society’s Patient Safety Committee synthesized available evidence related to hypothalamic-pituitary-adrenal axis suppression following epidural and intra-articular corticosteroid injections. The committee noted that studies have indicated an attenuation of the body’s immune response after a corticosteroid injection for pain indications, and this response appears greatest at 1 week following injection.

Analyses of early-stage and late-stage trial data found Johnson & Johnson’s Janssen COVID-19 vaccine generated cellular and humoral immune responses and also protected patients against infection with the novel coronavirus as early as 14 days after injection. In contrast, the Oxford-AstraZeneca vaccine reported efficacy at 15 days following the second vaccine dose.

In a phase 3 trial of Johnson & Johnson’s Janssen vaccine as well as the Oxford-AstraZeneca studies, corticosteroids were allowed, but the investigators did not perform subanalyses to determine whether steroid exposure impacted vaccine efficacy.

Given the lack of information on the association between corticosteroid use and COVID-19 vaccine efficacy, the committee recommends that clinicians time elective corticosteroid injections ≥2 weeks before and ≥2 weeks after vaccine administration. The committee emphasized that this window may not generalize to mRNA COVID-19 vaccines.

The committee wrote of the importance of a shared decision-making approach in identifying the best time window for corticosteroid injections for pain in relation to receipt of COVID-19 vaccination.

“These recommendations may change as more direct evidence regarding the effect of corticosteroid injection on COVID-19 adenovirus vector-based vaccine efficacy becomes available,” the committee wrote.


Lee H, Punt JA, Patel J, Stojanovic MP, Duszynski B, McCormick ZL; Spine Intervention Society’s Patient Safety Committee. Do corticosteroid injections for the treatment of pain influence the efficacy of adenovirus vector-based COVID-19 vaccines? Pain Med. Published online April 11, 2021. doi:10.1093/pm/pnab130