Table 2.

Clinical Scenarios of Patients with Systemic Autoimmune Disease at the Time of COVID-19 Vaccine Administration.

Clinical scenarios	Clinical characteristics and treatments used	Opportunity to administer the COVID-19 vaccine
SAD in remission or with low level of activity with low dose of PDN and without ISSa	No evidence of clinical or immunological activity, no use of PDN or 7.5 mg/day doses	Ideal situation to receive the vaccine Level of antibody production against the vaccine (potentially) comparable to persons without SAD
SAD in remission or with low level of activity with low dose PDN and with ISSa	No evidence of clinical or immunological activity, no use of PDN or 7.5 mg/day doses and with ISS	Ideal situation to receive the vaccine Level of vaccine antibody production (potentially) lower than in people without SAD
SAD with moderate or severe activity level, with intermediate-high doses of PDN and with ISSa	Clinical evidence of serious activity or serious organ compromise (life-threatening)	Treat SAD, avoid organ damage and life risk Once remission induction is achieved, plan vaccination The use of ISS in high doses does not ensure the efficacy of the vaccine
SAD on RTX treatment (or anticipated to receive)	No clinical evidence of serious activity or serious organ compromise (not life-threatening)	With stable SAD, vaccinate and postpone RTX 4 weeks If vaccine is not available, defer RTX if condition allows If RTX already received, wait 4–8 weeks to vaccinate

SAD: systemic autoimmune disease; PDN: prednisone; ISS: immunosuppressants; RTX rituximab.

^aIncludes synthesis ISS, biologics, and Janus kinase inhibitors.