Patients with autoimmune diseases are at higher risk for severe infection due to their underlying disease and immunosuppressive treatments. In this real-world observational study of 463 patients with autoimmune diseases, we examined risk factors for poor B and T cell responses to SARS-CoV-2 vaccination. We show a high frequency of inadequate anti–spike IgG responses to vaccination and boosting in the autoimmune population but minimal suppression of T cell responses. Low IgG responses in B cell–depleted patients with multiple sclerosis (MS) were associated with higher CD8 T cell responses. By contrast, patients taking mycophenolate mofetil (MMF) exhibited concordant suppression of B and T cell responses. Treatments with highest risk for low anti–spike IgG response included B cell depletion within the last year, fingolimod, and combination treatment with MMF and belimumab. Our data show that the mRNA-1273 (Moderna) vaccine is the most effective vaccine in the autoimmune population. There was minimal induction of either disease flares or autoantibodies by vaccination and no significant effect of preexisting anti–type I IFN antibodies on either vaccine response or breakthrough infections. The low frequency of breakthrough infections and lack of SARS-CoV-2–related deaths suggest that T cell immunity contributes to protection in autoimmune disease.


Erik Anderson, Michael Powell, Emily Yang, Ananya Kar, Tung Ming Leung, Cristina Sison, Rebecca Steinberg, Raven Mims, Ananya Choudhury, Carlo Espinosa, Joshua Zelmanovich, Nkemakonam C. Okoye, Eun Jung Choi, Galina Marder, Sonali Narain, Peter K. Gregersen, Meggan Mackay, Betty Diamond, Todd Levy, Theodoros P. Zanos, Arezou Khosroshahi, Ignacio Sanz, Eline T. Luning Prak, Amit Bar-Or, Joan Merrill, Cristina Arriens, Gabriel Pardo, Joel Guthridge, Judith James, Aimee Payne, Paul J. Utz, Jeremy M. Boss, Cynthia Aranow, Anne Davidson


Download this citation for these citation managers:

Or, download this citation in these formats:

If you experience problems using these citation formats, send us feedback.