Table 1.

Hypothesized modifiers of vaccine response and considerations in patients with autoimmune inflammatory diseases

Potential modifiers	Specific population group	Considerations
General viewpoints
Age	Elderly patients	Elderly patients may have diminished immune reactivity and reduced seroconversion rate due to, in part, the long-standing autoimmune inflammatory disease with its confounding effect
Gender	Male patients	Male gender may be associated with lower acceptance rate and lower rates of postvaccination seroconversion [36]
Immune history	Exposed to virus or vaccinated patients	“Immune imprinting” due to prior coronavirus exposure may affect both positively or negatively vaccine effectiveness [37]
Comorbidity	Obese and multimorbid patients	Obesity and end-organ damage may affect host response to vaccines due to altered T-cell function and reduced levels of interferon-gamma and granzyme B [38]
Autoimmune disease-specific viewpoints
Disease activity and duration	Patients with high disease activity and/or long-standing disease	The long-standing and active autoimmune inflammatory disease may affect immunogenicity by reducing seroconversion rates [39]
B cell depleting therapy	Rheumatic patients undergoing CD20 depleting therapy	B cell responses and thus, a serological response to vaccines are hindered by CD20 depletion therapy [17]
High-dose glucocorticoids and other immunosuppressive agents	Immunosuppressed patients	Variable impact on vaccine effectiveness with the majority of patients having satisfactory seroconversion rates [18]