Table 3.

Summarized study results on the efficacy of mRNA and AstraZeneca COVID-19 vaccines in patients with autoimmune rheumatic diseases.

Immune Response after COVID-19 Vaccines in Patients with ARD
Humoral response	•Positive seroconversion in 77–100 % in the absence of BCDT •Lower seroconversion with older age, interstitial lung disease and myositis •Higher seroconversion in the presence of previous COVID-19 infection •Rate of seroconversion was not affected by the type of ARD
Cellular response	•Vaccine-induced cellular immunity in 69 % to 82 % •Cellular response correlated with the humoral response except with BCDT use
Effect of Immunomodulatory Agents on COVID-19 Efficacy in Patients with ARD
Methotrexate	•No effect or reduced humoral and cellular responses •The immunological response might improve by holding one dose after vaccine administration
Mycophenolate mofetil	•Probably negative effect on the rate and level of humoral response •The humoral response could improve by a temporary hold of mycophenolate
Glucocorticoids	•Lower humoral response in a dose-dependent relation
other csDMARDs	•Azithromycin, leflunomide, teriflunomide, and 6-mercaptopurine were not associated with significant differences in vaccine immunogenicity
tsDMARDs	•No effect or reduced immunogenicity to mRNA vaccines
Tumor Necrosis Inhibitors	•Probably no effect on the humoral response •Might be associated with a modest reduction in cellular response
Rituximab	•Reduced seroconversion rate (10–49 %) •Lower seroconversion with rituximab included: older age, low IgM and/or IgG levels, lack of CD19 reconstitution, a shorter interval from the last rituximab dose, concomitant use of immunosuppressants, and rituximab dose •Higher seroconversion with prior COVID-19 infection and using a booster dose of vaccine •Positive cellular response in 53–71 %
The severity of breakthrough COVID-19 in vaccinated patients with ARD
More severe disease with the use of BCDT or mycophenolate and in the presence of comorbid lung disease
ARD: Autoimmune Rheumatic Disease; BCDT: B-Cell Depleting Therapy; DMARDs: Disease-Modifying Antirheumatic Drugs; csDMARDs: conventional synthetic DMARD; tsDMARDs: targeted synthetic DMARD