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Table 3 Immunosuppression degree conferred by drugs used to treat patients with chronic immune-mediated inflammatory diseases: Positioning of the Brazilian Societies of Rheumatology, Dermatology and Study Groups on Inflammatory Bowel Diseases

From: Brazilian recommendations on the safety and effectiveness of the yellow fever vaccination in patients with chronic immune-mediated inflammatory diseases

Non-immunosuppressed
 Those clinically stable under the following conditions:
 No drug treatment
 Only using sulfasalazine or hydroxychloroquine or mesalazine or acitretin
 Using topical, inhaled, peri or intra-articular corticosteroids
Low immunosuppression degree
 Using:
 Methotrexate at a dose of ≤0.4 mg/kg/week or ≤ 20 mg/week
 Leflunomide at a dose of ≤20 mg/daya
 Corticosteroid at a dose of ≤20 mg/day (or 2 mg/kg/day for patients weighing < 10 kg) prednisone or equivalent
High immunosuppression degree
 Using:
 Corticosteroid at a dose of ≥20 mg/day (or > 2 mg/kg/day for patients weighing < 10 kg) prednisone or equivalent, for a period ≥14 days
 Pulsotherapy with methylprednisolone
 Immunosuppressants as mycophenolate mofetil or sodic, cyclosporine, cyclophosphamide, tacrolimus, azathioprine
 JAK inhibitors, such as tofacitinibb
 b-DMARD
  1. bDMARD: biologic disease modifying anti-rheumatic drugs; As the dosage of serum level of leflunomide is difficult and the studies on the risk of vaccinating individuals taking leflunomide at the usual doses are lacked, in cases requiring vaccination, a drug elimination regimen of 8 g of cholestyramine 3 times/day for 11 days or 50 g of activated charcoal 4 times/day for 11 days must be prescribed (similar to Sanofi Pasteur Laboratory recommendation when a woman taking leflunomide become pregnant). If the leflunomide plasma level determination is available it is recommended to reach nondetectable levels (i.e., below 0.02 mg/l) before vaccination