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COVID Vaccination in SLE — SCE Rheumatology MCQ

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EasySLE & Antiphospholipid SyndromeCOVID Vaccination in SLESCE Rheumatology

A 45-year-old woman with SLE asks about COVID-19 vaccination. She is on Mycophenolate Hydroxychloroquine and Prednisolone 5 mg daily. According to current guidance what vaccine advice should be given?

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Correct answer: A — COVID-19 vaccination is recommended for all SLE patients on immunosuppression; response may be blunted by Mycophenolate so timing and additional doses may be considered

COVID-19 vaccination is strongly recommended for all immunosuppressed patients including those with SLE. However immunosuppressive medications (particularly Mycophenolate Rituximab and high-dose glucocorticoids) can blunt vaccine immunogenicity. BSR and JCVI guidance recommend additional doses for immunosuppressed patients. Timing considerations: BSR 2025 csDMARD guidelines recommend withholding Methotrexate for 2 weeks post-vaccination; Rituximab timing should aim for vaccination before the next cycle (ideally 4 weeks pre-dose or at least 6 months post-dose). Hydroxychloroquine does not significantly impair vaccine responses. Mycophenolate's impact is intermediate.

Reference: BSR 2025 csDMARD guidelines; JCVI COVID vaccination guidance for immunosuppressed