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Table 1 Recommendations related to COVID-19 vaccination in patients with immune-mediated rheumatic diseases

From: Guidelines on COVID-19 vaccination in patients with immune-mediated rheumatic diseases: a Brazilian Society of Rheumatology task force

Recommendations

LOA

1. Based on their risk for COVID-19, patients with IMRD should be encouraged to get their COVID-19 vaccination in a shared-making decision process

100%

2. The decision on the best timing to be vaccinated with COVID-19 vaccines should be individualized, considering the patient's age, the underlying IMRD, and its treatment, aiming to optimize the vaccine response

100%

3. COVID-19 vaccination should ideally occur in the setting of stable disease activity in patients with IMRD and absence or low immunosuppression

95.9%

4. The rheumatologist should inform their patients on the possibility of not effective vaccine response, especially those under high immunosuppression

100%

5. Immunomodulatory or immunosuppressive treatment in patients with IMRD should not be discontinued before and or after receiving COVID-19 vaccines, except for B-cell depleting agents (e.g., rituximab)

95.8%

6. COVID-19 vaccination should be ideally done 6 months after the last dose of rituximab and four weeks before the next one considering the complete vaccination schedule

*If this is not possible, this recommendation should be followed at least for the first dose

95.8%

7. IMRD patients should receive the same COVID-19 vaccine platform in the complete schedule

*In cases of severe adverse events (anaphylaxis) or immediate reactions (urticaria, angioedema, or respiratory distress) to any vaccine platform, an alternative approach is recommended for additional doses following local availability

95.8%

8. An additional dose of the COVID-19 vaccine should be considered for patients with IMRD who completed their vaccination schedule

100%

9. The additional dose should preferably be with a COVID-19 vaccine platform different than that used in the primary COVID-19 vaccination schedule

95.8%

10. Temporary interruption of immunomodulatory drugs before an additional dose of COVID-19 vaccines for patients with IMRD should not be recommended

91.7%

11. Temporary interruption of rituximab should not be recommended concerning the COVID-19 vaccine additional dose

*Until high-quality evidence is available

83.4%

12. COVID-19 vaccines can be administered simultaneously with the other vaccines

92.3%

13. Assessment for seroconversion after COVID-19 vaccination is not recommended

95.9%

14. Seasonal influenza and pneumococcus vaccination are strongly recommended for patients with IMRD

* It is essential to keep vaccination cards updated

92.3%

15. Vector viral COVID-19 vaccine should be recommended for patients with IMRD and thrombocytopenia or previous thrombotic events

95.9%

16. Pregnant patients with IMRD should receive only non-vector viral COVID-19 vaccines

*Until new safety evidence is available for this scenario

100%

17. Children and adolescents (12–17 years) with IMRD should receive COVID-19 vaccination

95.8%

  1. IMRD: immune-mediated rheumatic diseases