key: cord-0740831-nm2bqjsi
authors: Benucci, Maurizio; Infantino, Maria; Manfredi, Mariangela; Gobbi, Francesca Li; Sarzi-Puttini, Piercarlo; Caproni, Marzia
title: Covid vaccination in patients with autoimmune diseases treated with mycophenolate: Let's think back to the recommendations
date: 2021-07-16
journal: Autoimmun Rev
DOI: 10.1016/j.autrev.2021.102908
sha: 118002c3b533c7455db97fd6976691b0f902aafa
doc_id: 740831
cord_uid: nm2bqjsi

nan

force comprising 9 rheumatologists / immunologists, 2 infectious disease specialists and 2 public health physicians was assembled and declared moderate consensus in delaying vaccination for SARS-CoV-2 in patients treated with Mycophenolate in the RMDs [4] . In the documents of the Italian Society of Rheumatology of March-13-2021 and the Italian Society of Dermatology and Venereology of February 24-2021, reference is made to the clinician's decisions in delaying or suspending immunosuppressive therapies with the exception of Rituximab (RTX), translating some concepts that have emerged on the international literature [3] [4] . Vaccination in the Italian population initially involved health service operators and religious professions as well as elderly people hospitalized in institutionalized structures. The mRNA vaccines of Moderna and Pfizer / BioNTech do not include adjuvants of any sort, thus decreasing the probability for any unwanted immune modulation [4] . In table 1 we report detailed informations of two nuns suffering from Systemic Lupus Erythematosus (patients 1-2), and a hospital nutritionist suffering from Pemphigus terms of efficacy and safety [5] . Two recent studies show that patients with RMD have neutralizing IgG antibody production after vaccination for SARS-CoV-2 with RNA vaccines. In the first report on 26 patients the antibody titer is lower than the general population, but in the group evaluated J o u r n a l P r e -p r o o f there are no patients treated with mycophenolate [6] . In the second study on 123 patients, of which eleven evaluated in treatment with mycophenolate, in three neutralizing antibodies were determined, while in eight were absent [7] . The authors underline the attention to the treatment with mycophenolate as well as with RTX, in the response to vaccination. In our study only one out the three patients was taking Prednisone 2.5 mg day, was on stable treatment with mycophenolate and in clinical remission. We do not yet know the withdrawal times of this therapy as it has been proposed for other DMARDs and b-DMARDs during the vaccination for SARS-CoV-2 [3] .

However, it is reasonable to think that due to its half-life of 8-16 hours, even Mycophenolate can be discontinued in the week of the first vaccination and booster. Our three cases want to focus on the problem and be a starting point for future research.

This article has no funding source. 

COVID-19 epidemiology in rheumatic diseases in Tuscany: A case-control study

View points on SARS-CoV-2 vaccination in patients with RMDs

American College of Rheumatology Guidance for COVID-19 Vaccination in Patients with Rheumatic and Musculoskeletal Diseases -Version 1. Arthritis Rheumatol

The SARS-CoV-2 as an instrumental trigger of autoimmunity

SARS-CoV-2 vaccines in patients with SLE

Immunogenicity and safety of anti-SARS-CoV-2 mRNA vaccines in patients with chronic inflammatory conditions and immunosuppressive therapy in a monocentric cohort

Antibody response to a single dose of SARS-CoV-2 mRNA vaccine in patients with rheumatic and musculoskeletal diseases