In this study, we conducted a comprehensive serological and cellular analysis of patients with autoimmune systemic lupus erythematosus (SLE) who received the Wuhan-Hu-1 monovalent mRNA coronavirus disease 2019 vaccine. Our findings revealed that patients with SLE exhibited reduced avidity of anti-receptor-binding domain antibodies, leading to decreased neutralization potency and breadth.

In our SLE cohort, we also observed reduced seroconversion associated with treatment with mycophenolate mofetil. Yet, in contrast to findings in kidney transplant recipients, the second and third doses were able to rescue the initially deficient responses in these patients.

Globally, the knowledge acquired in this study should form the basis for new strategies to enhance the efficacy and durability of mRNA vaccinations, including modifications of vaccine dosing and timing and modulation of the magnitude and/or timing of the administration of immunosuppressive agents.