Table 2.
Suggested prioritization grading according to IMIDs-related risk factors.
| IMIDs | IMIDs-related risk factors | Grading |
|---|---|---|
| IBD | IBD patients on biologic therapy (gut-selective) or immunosuppressants (azathioprine) or active IBD IBD patients on biologic therapy (non-gut-selective) Non-immunosuppressed inactive IBD patients (untreated or mesalamine-treated) Recent high-dose steroid therapy |
+++ ++ + +/- (consider delay) |
| Rheumatic Diseases | Rheumatic disease patients on biologic therapy or immunosuppressants (including ≥ 10 mg/day of prednisone) Rheumatic disease patients with a history of severe infections Active rheumatic disease (e.g. high anti-CCP titer) Non-immunosuppressed patients with inactive disease Therapy with Rituximab |
+++ ++ ++ + +/- (consider delay) |
| Immune-mediated Glomerular Diseases | IMGD patients on immunosuppressants (Cyclophosphamide, Mycophenolic acid, Cyclosporin/Tacrolimus) or active glomerular disease Stable, inactive IMGD patients (untreated) IMGD patients on anti-CD20 therapy (Rituximab) or recent high-dose steroid therapy |
+++ + + (consider delay) |
| Cutaneous Diseases | Patients with autoimmune bullous diseases candidate to anti-CD20 therapy (vaccination should be scheduled at least 4 weeks before anti-CD20 therapy initiation) Patients on biologic therapy (anti-TNFα, anti-IL-17, anti-IL12/23) or conventional immunosuppressants (azathioprine, mycophenolate mofetil, cyclosporine) Patients with immune-mediated skin diseases treated with low dosages of systemic corticosteroids or untreated Patients treated with atopic dermatitis treated with dupilumab Patients with immune-mediated skin diseases treated with high dosages of systemic corticosteroids Patients with autoimmune bullous diseases treated with anti-CD20 therapy in the last 12-20 weeks |
+++ ++ + + +/- (consider delay) +/- (consider delay) |
| Ocular Diseases | Patients with ocular conditions candidate to anti-CD20 therapy (vaccination should be scheduled at least 4 weeks before anti-CD20 therapy initiation) Patients with uveitis on biologic therapy (anti-TNFα, anti-IL-17, anti-IL12/23) or conventional immunosuppressants (azathioprine, mycophenolate mofetil, cyclosporine) Patients with uveitis with low dosages of systemic corticosteroids or untreated Patients with retinal diseases who need frequent access to the hospital for intravitreal treatment/monitoring Patients with acute autoimmune uveitis treated with high dosages of systemic corticosteroids Patients with autoimmune uveitis treated with anti-CD20 therapy in the last 12-20 weeks |
+++ ++ + + +/- (consider delay) +/- (consider delay) |
| Type 1 Diabetes Mellitus | Adult patients with type 1 Diabetes Mellitus with poor glycemic control and/or cardiovascular or renal complications Adult patients with type 1 Diabetes Mellitus |
+++ ++ |
| Chronic Pulmonary Diseases | Severe COPD/Severe asthma/ILDs/IPF Mild-moderate COPD/asthma/bronchiectasis Bronchiectasis secondary to innate or acquired immunodeficiencies/ILDs with immunosuppressive treatments |
+++ ++ +/- (multidisciplinary discussion/consider avoiding inactivated vaccine) |
+++ indicates high priority patients.
++ indicates moderate priority patients.
+ indicates mild priority patients.
+/- consider delay and/or multidisciplinary management.
IMIDs, immune-mediated inflammatory diseases; IBD, inflammatory bowel disease; anti-CCP, anti–cyclic citrullinated peptide; IMGD, immune-mediated glomerular disease; TNFα, tumor necrosis factor; COPD, chronic obstructive pulmonary disease; ILDs, interstitial lung diseases; IPF, idiopathic pulmonary fibrosis.