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MMF and Vaccination — SCE Rheumatology MCQ

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ModerateRheumatology PharmacologyMMF and VaccinationSCE Rheumatology

A 40-year-old woman with SLE and lupus nephritis has been on Mycophenolate for 2 years maintaining remission. She is also on Hydroxychloroquine and Prednisolone 4 mg daily. She has recently been advised to receive the pneumococcal polysaccharide vaccine (PPV23). Should Mycophenolate be withheld around vaccination?

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Correct answer: B — Current evidence does not support routinely withholding Mycophenolate for inactivated vaccines (unlike Methotrexate); however vaccine response may be suboptimal and additional doses may be needed

Unlike Methotrexate (for which BSR 2025 recommends a 2-week post-vaccination hold) there is currently no specific recommendation to withhold Mycophenolate around inactivated vaccination though it is known to blunt vaccine responses. Mycophenolate inhibits inosine monophosphate dehydrogenase affecting B-cell and T-cell proliferation which can reduce antibody production after vaccination. Patients on Mycophenolate may require additional vaccine doses to achieve protective antibody levels. JCVI and specialist guidance recommend that immunosuppressed patients receive all recommended inactivated vaccines with consideration of additional doses for suboptimal responders.

Reference: BSR 2025 csDMARD guidelines; JCVI Green Book immunisation of immunosuppressed