Table 4.
Different drugs and the impact on humoral and cellular immune vaccine response: a summary of the level of evidence and factors influencing it
| Drugs | Humoral-immune vaccine response | Cellular-immune vaccine response | Clinical perspective | Factors influencing response |
|---|---|---|---|---|
| Steroids | S1/S2 SARS-CoV-2/neutralizing antibody response ↓/↓ | →/↓ (limited evidence) | T cell response might be impaired with higher doses; overall low evidence | Dose-dependent reduced antibody response; impaired cellular response might be dose dependent |
| Mycophenolic acid | S1/S2 SARS-CoV-2/neutralizing antibody response ↓/↓ | → (limited evidence) | Antibody response significantly reduced by MMF; unclear evidence related to cellular immune response | Reduced doses associated with response in KTR; transient hold of MMF after vaccine administration (1 week) |
| Azathioprine | S1/S2 SARS-CoV-2/neutralizing antibody response →/→ | → (limited evidence) | Humoral response seems to be preserved; no information on cellular response | – |
| Calcineurin inhibitors | S1/S2 SARS-CoV-2/neutralizing antibody response ↓/↓, in IMKD limited evidence (→) | T cell response impaired (limited evidence) | Humoral response in KTR significantly reduced and cellular response in IMKD | Presumably a dose-dependent weakened antibody response (time from transplantation to vaccination improves response) |
| CD20-depleting agents | S1/S2 SARS-CoV-2/neutralizing antibody response ↓/↓ | Controversial evidence, T cell response →, ↓ | No or only marginal humoral response when rituximab is administered 6 months before vaccination | Presence of CD19 cells, timing (>6 months) and higher CD4 T lymphocytes predict response |
| Belimumab | S1/S2 SARS-CoV-2/neutralizing antibody response →↓/→↓ | – | A reduced antibody response and lower seroconversion rate should be expected | – |
| Alkylating agents (i.e. cyclophosphamide) | S1/S2 SARS-CoV-2/neutralizing antibody response (probably ↓/↓) | (probably impaired) | No concrete recommendation possible based on current evidence | – |
| Complement inhibitors | S1/S2 SARS-CoV-2/neutralizing antibody response (probably →/→) | (probably unaffected) | No concrete recommendation possible based on current evidence | – |
IMKD, immune-mediated kidney disease; KTR, kidney transplant recipient.