COVID-19 Booster Vaccine in Autoimmune Disease Non-Respon... | NCT05000216

ID	Type	Description	Link
NIAID CRMS ID#: 38873	Other Identifier	DAIT NIAID

Name	Class
Autoimmunity Centers of Excellence	OTHER
Rho Federal Systems Division, Inc.	INDUSTRY

Description Module

Detailed Description

Adult Population:

Stage 1 of this trial will enroll up to a maximum of 900 adult study participants (up to 60 participants per arm).

Participants will be assigned to one of 3 cohorts based on their IS regimens:

Cohort A: Receipt of MMF or MPA
Cohort B: Receipt of MTX
Cohort C: Receipt of any BCDT within the past 18 months.

Treatment Arms: Participants in Cohorts A, B, and C will be assigned to receive an additional dose of the same COVID-19 vaccine as their original vaccine series. The trial initially enrolled participants who were vaccinated with the Pfizer-BioNTech COVID-19 Vaccine, the Moderna COVID-19 Vaccine, and the Janssen COVID-19 Vaccine. Update: Arms to receive an additional homologous vaccine dose after an initial Janssen COVID 19 Vaccine were closed to enrollment after the CDC updated its recommendations to express a clinical preference for individuals to receive an mRNA COVID-19 vaccine over the Janssen COVID-19 vaccine. All Adult Stage 1 treatment arms were closed to enrollment on 15 August 2022.

Participants in Cohorts A and B will be randomized into 2 IS medication treatment plans as follows:

Participants continue to take their cohort-defining IS medications without alterations in schedule and dosing.
Participants withhold their cohort-defining IS medications before and after the additional homologous vaccine dose per protocol instructions.

A participant will be enrolled in the study for a maximum of approximately 13 months.

Stage 2 of this trial will include up to a maximum of 960 adult study participants (up to 80per arm) with a Roche Elecsys® Anti-SARS-CoV-2 S result ≤2500 U/mL after previous COVID-19 vaccine administration (at least 3 doses of mRNA vaccine(s) or 2 doses of the Janssen COVID-19 Vaccine). Participants will be eligible to receive a dose of an alternative COVID-19 vaccine.

Participants may have received their previous COVID-19 vaccine prior to enrollment in the study ("newly recruited participant"), or they may have received their previous COVID-19 vaccine as a study participant and then (re-) enter into Stage 2 ("rollover participant"). Participants can also roll over into Stage 2 via two pathways:

Stage 1 participant rolls over to Stage 2
Stage 2 participant rolls over to a different Stage 2 treatment arm

Participants will be allocated to 1 of 3 cohorts based on their IS regimens:

Cohort D: Receipt of MMF or MPA
Cohort E: Receipt of MTX
Cohort F: Receipt of any BCDT within the past 18 months.

Treatment Arms: Participants in Cohorts D, E, and F will receive a dose of an alternative COVID-19 vaccine compared to their previous COVID-19 vaccine doses. Originally, participants who previously received 3 total doses of a single mRNA vaccine (Moderna COVID-19 Vaccine OR Pfizer- BioNTech COVID-19 Vaccine) received their choice of either the Janssen vector-based COVID-19 vaccine or the other mRNA COVID-19 vaccine, and participants who previously received 2 doses of the Janssen vector based COVID-19 vaccine received the Moderna COVID-19 Vaccine.

Update: Beginning with v4.0 of the protocol, this trial will not utilize the Janssen vector-based COVID-19 vaccine. Participants who previously received 3 total doses of a single mRNA vaccine will receive their choice of an alternative mRNA COVID-19 vaccine or the Sanofi-GSK protein based COVID-19 vaccine. Participants who previously received 4 or more doses of a single mRNA vaccine or 3 or more doses of a mixture mRNA vaccines (Moderna COVID-19 Vaccine AND Pfizer-BioNTech COVID-19 Vaccine, in any order or combination) will receive the Sanofi-GSK protein-based COVID-19 vaccine.

Participants in Cohorts D and E will withhold their cohort-defining IS medications before and after the alternative vaccine dose per protocol instructions. Participants in Cohort F who are taking MMF, MPA, or MTX in addition to BCDTs will withhold these medications before and after the alternative vaccine dose per protocol instructions.

Visits to assess endpoints will occur at Baseline (Week 0), Week 4 ± 1 week, Week 12 ± 2 weeks, Week 24 ± 2 weeks, Week 36 ± 2 weeks, and Week 48 ± 2 weeks. A participant who is newly recruited to the study for entry into Stage 2 may be on study for up to a maximum of 13 months. A participant who enters Stage 2 after a serologic negative, suboptimal, or low immune response to their Stage 1 vaccine dose may be on study for up to a maximum of 26 months. Rollover participants will discontinue follow-up as part of Stage 1 upon rollover into Stage 2. A participant who rolls over to a different Stage 2 treatment arm 2 after a serologic negative, suboptimal, or low immune response to another Stage 2 vaccine dose may be on study for up to a maximum of 38 months.

Pediatric Population:

Stage 1 in the pediatric portion of this trial will enroll up to a maximum of 800 participants (2-17 years of age) with a Roche Elecsys® Anti-SARS-CoV-2 S result ≤2500 U/mL after receiving an initial COVID-19 vaccine regimen (up to 80participants per arm). Vaccines will be included in this protocol as they receive EUA or approval by FDA for a given age group. Pediatric participants will have 1 of 4 autoimmune diseases: pediatric SLE, juvenile idiopathic arthritis (JIA), juvenile dermatomyositis (JDM), or pediatriconset multiple sclerosis (POMS). Participants will be assigned to 1 of 3 cohorts based on their IS regimens:

Cohort A: Receipt of MMF or MPA
Cohort B: Receipt of MTX
Cohort C: Receipt of any BCDT within the past 18 months.

Treatment Arms: Participants in Cohorts A, B, and C will be assigned to receive an additional dose of the same vaccine as their original vaccine series. Based on FDA EUA status, pediatric participants were initially eligible to receive the Pfizer-BioNTech COVID-19 Vaccine only.

Participants in Cohorts A and B will be randomized into 2 IS medication treatment plans as follows):

Participants continue to take their cohort-defining IS medications without alterations in schedule and dosing.
Participants withhold their cohort-defining IS medications before and after the additional homologous vaccine dose per protocol instructions.

A participant will be enrolled in the study for a maximum of approximately 13 months.

Stage 2 of the pediatric portion of this trial will include up to a maximum of 480 pediatric study participants (up to 80 per arm) with a Roche Elecsys® Anti-SARS-CoV-2 S result ≤2500 U/mL after previous COVID-19 vaccine administration (an age-appropriate EUA-authorized or FDA-approved initial COVID-19 vaccine regimen plus 1 additional dose of the same vaccine). All participants (2-17 years of age) who previously received doses of the Pfizer-BioNTech COVID-19 Vaccine are eligible to receive an age-appropriate dose of the Moderna COVID-19 Vaccine. Participants 12 through 17 years of age who previously received doses of the Moderna COVID-19 vaccine are eligible to receive an age-appropriate dose of the Pfizer-BioNTech COVID-19 Vaccine. Participants will be eligible to receive a dose of an alternative COVID-19 vaccine. Participants may have received their previous COVID-19 vaccine as a study participant and then enter into Stage 2 ("rollover participant"), or they may have received their previous COVID-19 vaccine prior to enrollment in the study ("newly recruited participant").

Participants will be allocated to 1 of 3 cohorts based on their IS regimens:

Cohort D: Receipt of MMF or MPA (± other rheumatic disease medications, including biologics)

o Participants who are taking MMF or MPA (without additional B cell depleting medications or MTX) will be placed in this cohort.
Cohort E: Receipt of MTX (± other rheumatic disease medications, including biologics)

o Participants who are taking MTX (without additional B cell depleting medications or MMF/ MPA) will be placed in this cohort.
Cohort F: Receipt of B cell depletion therapy within the past 18 months (± other rheumatic disease medications) o Participants taking B cell depletion medications, regardless of whether they are also taking MMF or MTX, will be placed in this cohort.

Treatment Arms: Participants in Cohorts D, E, and F will receive a dose of an alternative COVID-19 vaccine compared to their previous COVID-19 vaccine doses. Participants who previously received age-appropriate doses of a single mRNA vaccine (Moderna COVID-19 Vaccine OR Pfizer-BioNTech COVID-19 Vaccine, as noted above) will receive the other mRNA COVID-19 vaccine.

Beginning with v7.0 of the protocol all vaccines used are bivalent versions replacing original monovalent versions.

Participants in Cohorts D and E will withhold their cohort-defining IS medications before and after the alternative vaccine dose per protocol instructions (see Section 7.1.1 Protocol-mandated Medications).

Participants in Cohort F who are taking MMF, MPA, or MTX in addition to B cell depletion therapies (BCDTs) will withhold these medications before and after the alternative vaccine dose per protocol instruction.

A participant who enters Stage 2 after a serologic negative, suboptimal, or low immune response to their Stage 1 vaccine dose may be on study for up to a maximum of 26 months. Rollover participants will discontinue follow-up as part of Stage 1 upon rollover into Stage 2. A participant who is newly recruited to the study for entry into Stage 2 may be on study for up to a maximum of 13 months.

Adaptive Design

An adaptive design will be employed such that cohorts and arms defined by additional vaccine doses and IS treatment plans may be added or modified based on emerging data from existing and new FDA Emergency Use Authorization (EUA) or approvals of COVID-19 vaccines:

New cohorts may be defined based on changes in the medication groups if it becomes obvious that certain medications are highly associated with suboptimal or low immune serologic response to initial COVID-19 vaccine regimen.
Cohorts may limit or expand the autoimmune diseases that are eligible to be included in the clinical trial and may include expansion cohorts of underrepresented diseases.
New cohorts may include participants whose antibody response falls to suboptimal or low immune levels over time.
Based upon timing of the FDA EUA authorization for children of each of the COVID-19 vaccines used in this trial, the age range of the inclusion criteria may be expanded.
Allocation or randomization to treatment with new COVID-19 vaccines may be incorporated into the design when the products become available.
Identification of additional strategies to enhance vaccine responsiveness in autoimmune diseases, including a temporary switch of immunomodulatory medications.

Label	Type	Description	Intervention Names
Cohort A, Arm A1: Moderna mRNA-1273 + Continue IS (MMF or MPA)	Experimental	Adult participants who are taking MMF or MPA (without additional B cell depleting medications or MTX) for management of their underlying autoimmune disease will receive an additional dose of the Moderna COVID-19 vaccine and continue to take their immunosuppressive medications (IS) without alterations in schedule and dosing.	Biological: Moderna mRNA-1273 Drug: Continue IS (MMF or MPA)
Cohort A, Arm A2: BNT162b2 + Continue IS (MMF or MPA)	Experimental	Adult participants who are taking MMF or MPA (without additional B cell depleting medications or MTX) for management of their underlying autoimmune disease will receive an additional dose of the Pfizer-BioNTech COVID-19 vaccine and continue to take their immunosuppressive medications (IS) without alterations in schedule and dosing.	Biological: BNT162b2 Drug: Continue IS (MMF or MPA)
Cohort A, Arm A3: Ad26.COV2.S + Continue IS (MMF or MPA)	Experimental	Arm closed, effective protocol version 3.0. Adult participants who are taking MMF or MPA (without additional B cell depleting medications or MTX) for management of their underlying autoimmune disease will receive the Janssen COVID-19 vaccine booster (1 dose) and continue to take their immunosuppressive medications (IS) without alterations in schedule and dosing.	Biological: Ad26.COV2.S Drug: Continue IS (MMF or MPA)
Cohort A, Arm A4: Moderna mRNA-1273 + Withhold IS (MMF or MPA)	Experimental

Name	Type	Description	Arm Group Labels	Other Names
Moderna mRNA-1273	Biological	Administration: One dose administered intramuscularly.	Cohort A, Arm A1: Moderna mRNA-1273 + Continue IS (MMF or MPA) Cohort A, Arm A4: Moderna mRNA-1273 + Withhold IS (MMF or MPA)

Measure	Description	Time Frame
Percent of Stage 1 Adult Participants Who Have a Protective Antibody Response at Week 4	Antibody response was measured using the National Institute of Allergy and Infectious Disease Vaccine Research Center (NIAID-VRC) Meso Scale Discovery (MSD) 3 plex assay (Wu-1 full-length spike, receptor binding domain (RBD), and N proteins). A threshold for achieving a protective antibody response was not established for the NIAID VRC MSD assay. The intent was to use a pre-established threshold to define a protective antibody response. However, correlates from previous studies could not be extrapolated to the CoV-2 variants circulating over the entire course of this trial.	Week 4 Status Post Receipt of COVID-19 Vaccination
Percent of Stage 2 Adult Participants Who Have a Protective Antibody Response at Week 4	Antibody response was measured using the National Institute of Allergy and Infectious Disease Vaccine Research Center (NIAID-VRC) Meso Scale Discovery (MSD) 3 plex assay (Wu-1 full-length spike, receptor binding domain (RBD), and N proteins). A threshold for achieving a protective antibody response was not established for the NIAID VRC MSD assay. The intent was to use a pre-established threshold to define a protective antibody response. However, correlates from previous studies could not be extrapolated to the CoV-2 variants circulating over the entire course of this trial.	Week 4 Status Post Receipt of COVID-19 Vaccination
Percent of Stage 2 Pediatric Participants Who Have a Protective Antibody Response at Week 4	Antibody response was measured using the National Institute of Allergy and Infectious Disease Vaccine Research Center (NIAID-VRC) Meso Scale Discovery (MSD) 3 plex assay (Wu-1 full-length spike, receptor binding domain (RBD), and N proteins). A threshold for achieving a protective antibody response was not established for the NIAID VRC MSD assay. The intent was to use a pre-established threshold to define a protective antibody response. However, correlates from previous studies could not be extrapolated to the CoV-2 variants circulating over the entire course of this trial.	Week 4 Status Post Receipt of COVID-19 Vaccination

Measure	Description	Time Frame
Percentage of Stage 1 Adult Participants Who Seroconverted	Antibody response was measured using the National Institute of Allergy and Infectious Disease Vaccine Research Center Meso Scale Discovery 3 plex assay. For concentrations below the lower limit of detection (LLOD), numeric values equivalent to LLOD/2 were assigned; concentrations above the upper limit of quantification were reported without adjustments. Antibody results collected after a documented COVID-19 infection, monoclonal antibody use, or COVID-19 vaccine given off-study were excluded from the analyses. Participants missing antibody data were considered missing-completely-at-random. Seroconversion was assessed in the subgroup of participants who were anti-COVID-19 antibody negative at Week 0; defined as a result less than or equal to the positive threshold value (spike=10.8424, RBD=14.0858). Anti-COVID-19 antibody negative at Week 0 is defined separately for spike and RBD. Seroconversion was defined as having a result greater than the positive threshold at the Week 4 visit.

Eligibility Module

Eligibility Criteria

General Adult Inclusion Criteria:

1. Willing and able to sign informed consent 2. Documented full COVID-19 vaccination (CDC card or documentation in medical records) that was completed at least 4 weeks prior and no more than 52 weeks prior to the Stage 1 Screening visit, or if participating in Stage 2, no more than 48 weeks prior to the Stage 2 Screening visit.

General Exclusion Criteria 2. History of severe allergic reaction to the initial COVID-19 vaccine regimen, to any component of any of the COVID-19 vaccines, or to polyethylene glycol (PEG).

3. New diagnosis of malignancy that will require chemotherapy or immunotherapy, or ongoing treatment for a malignancy with chemotherapy or immunotherapy.

4. Active disease (per the Investigator's decision) resulting in inability to hold the IS therapy in the MMF/MPA or MTX arms of the study.

a. The potential impact of temporarily holding medication for participants with a recent mild disease flare within 4 weeks should be carefully considered.

5. Active disease during the Screening period resulting in:

An increase/addition of any IS medications, or
A suggestion of MS relapse per the investigator. 6. Recent or current SARS-CoV-2 infection defined as:

Documented SARS-CoV-2 infection in the past 30 days (from the day the participant is diagnosed by positive test to Screening).
Positive result on a molecular COVID-19 test at Screening. 8. Inflammatory myocarditis/pericarditis within 6 weeks of any COVID-19 vaccine doses.

9. Participants with active, ongoing chronic infections. Note: Participants are permitted to be on chronic prophylactic antimicrobial therapy. Adults with evidence of HIV, Hepatitis B indicated by surface antigen, and Hepatitis C indicated by anti-hepatitis C antibody positivity will be excluded. If an adult is negative for Hepatitis C viral load at Screening, he/she will be eligible to participate.

10. Participants with common variable immunodeficiency disease, as well as any participants currently receiving immune globulin replacement therapy. Note: Pediatric participants on IVIG therapeutically may enter the study provided they have sufficiently quiet disease that they can withhold their IVIG from 8 weeks prior to the Screening visit through 4 weeks after vaccination.

11. Participants who received licensed or investigational monoclonal antibodies or plasma products directed against SARS-CoV-2 within 30 days of Screening.

12. Participants who have received any live vaccines within 2 months of the anticipated study vaccine dose or who will have need of a live vaccine at any time during the study.

13. Currently pregnant or breastfeeding (For pediatric participants postmenarchal females must have a negative urine pregnancy test at Screening).

15. Hemoglobin (Hgb) <8.0 g/dL (80 g/L) 16. Past or current medical problems or findings from physical examination or laboratory testing that are not listed above, which, in the opinion of the investigator, may pose additional risks from participation in the study, may interfere with the participant's ability to comply with study requirements or that may impact the quality or interpretation of the data obtained from the study.

17. Other investigational chemical agent within 30 days or other investigational biologic agent within 8 weeks or 5 half-lives (whichever is longer) of Screening.

18. Concurrent treatment with cyclophosphamide. Adult participants taking cladribine, alemtuzumab, or mitoxantrone will also be excluded.

19. Participants currently on any type of dialysis, or who have received a solid organ transplant.

20. Prisoners or participants who are compulsorily detained (involuntarily incarcerated) for treatment of either a psychiatric or physical (e.g., infectious disease) illness.

21. Taking both MMF/MPA and MTX. 22. Receiving other investigational BCDT as part of a clinical trial within 18 months of Screening, unless drug assignment is known and the participant received an anti-CD20 or CD19 drug.

23. Participants with active systemic infections who have received systemic antimicrobials within the 14 days prior to Screening.

Adult General Criteria

Inclusion Criteria:
1. Individuals 18 years of age or older that meet classification criteria for systemic lupus erythematosus (SLE), systemic sclerosis (SSc), rheumatoid arthritis (RA), multiple sclerosis (MS), or pemphigus
2. Participants must meet the 2019 ACR/EULAR or 2012 SLICC classification criteria for SLE, the 2010 ACR/EULAR classification criteria for RA, the 2013 EULAR/ACR classification criteria for SSc, the 2017 McDonald criteria for MS, and the international consensus criteria for pemphigus.

If a participant has been diagnosed with more than one autoimmune disease, the participant will be assessed based on the disease that is selected for study entry 6. Must be currently taking one of the following IS medications with or without additional disease-related medications: MMF (minimum of 1000 mg per day)/MPA (minimum of 720 mg per day), MTX (minimum of 7.5mg per week), or B cell depleting agents within the past 18 months (such as rituximab, ocrelizumab, ofatumumab).

If taking MMF/MPA or MTX, the participant must have initiated therapy at least 8 weeks prior to randomization and be taking the same medications (regardless of dose) as at the time of the initial COVID-19 vaccine regimen. Note: Participants who withheld their IS medications around their initial vaccinations are eligible to participate.
If enrolling in the BCDT cohort, the participant must have received an anti-CD20 or an anti-CD19 BCDT in the past 18 months.

7. No changes in background IS medications, including MMF/MPA or MTX, in the 4 weeks prior to Screening, excluding the following:

HCQ,
Intraarticular steroids,
The addition of prednisone at ≤10mg per day or prednisone at any dose when given for ≤3 days, and
Corticosteroid bursts for non-autoimmune disease-related conditions, such as asthma or COPD, are permitted.

Adult General Exclusion Criterion 1. Inability or unwillingness of a participant to give written informed consent or comply with study protocol.

14. Adult female participants who are planning a pregnancy during the course of the trial.

Adult Stage 1-Specific Inclusion Criterion 5. Negative or suboptimal serologic response to initial COVID-19 vaccine regimen, defined as an Elecsys® Anti-SARS-CoV-2 S result ≤200 U/mL, at Screening visit.

Initial COVID-19 vaccine regimen is defined as either:

i.2 doses of the Pfizer-BioNTech COVID-19 Vaccine ii. 2 doses of the Moderna COVID-19 Vaccine

Adult Stage 1-Specific Exclusion Criterion 7. Receipt of a COVID-19 vaccine booster prior to Screening with the Moderna COVID-19 Vaccine, Pfizer-BioNTech COVID-19 Vaccine, or Janssen COVID-19 Vaccine.

Adult Stage 2 (Newly Recruited)-Specific Inclusion Criteria 2. History of severe allergic reaction to the COVID-19 vaccine, or to any component of the COVID-19 vaccine, that is to be administered in Stage 2, including polysorbate for participants receiving the Sanofi-GSK COVID-19 Vaccine, or to PEG.

5. Negative or suboptimal serologic response to a previous COVID 19 vaccine administration in one of the qualifying regimens, defined as an Elecsys® Anti-SARS-CoV-2 S (RBD) negative result or positive result of ≤200 U/mL, or a low immune response, defined as an Elecsys® Anti-SARS-CoV-2 S (RBD) result of ≤2500 U/mL, within 4 weeks of the Stage 2 Baseline/Week 0 visit. The regimens of COVID-19 vaccination that qualify are as follows:

3 doses of the Pfizer-BioNTech COVID-19 Vaccine
3 doses of the Moderna COVID-19 Vaccine
2 doses of the Janssen COVID-19 Vaccine
4 or more doses of a single mRNA vaccine (Pfizer-BioNTech COVID-19 Vaccine OR Moderna COVID-19 Vaccine)
3 or more doses of a mixture of mRNA vaccines (Pfizer-BioNTech COVID-19 Vaccine OR Moderna COVID-19 Vaccine)

Adult Stage 2 (Newly Recruited)-Specific Exclusion Criteria:

7. Receipt of a mixture of Janssen COVID-19 vaccines and mRNA COVID-19 vaccines (in any order or combination) prior to Stage 2 Screening.

Adult Stage 2 (Rollover)-Specific Inclusion Criteria:

Individuals who were previously enrolled in Adult Stage 1 or Adult Stage 2 will have met some inclusion and exclusion criteria at that time. Only a subset of the criteria for (re-)entering Adult Stage 2 will be assessed in rollover participants at the time of screening for Stage 2.

Individuals who meet all of the following criteria are eligible to (re )enter Adult Stage 2:

2. History of severe allergic reaction to the COVID-19 vaccine, or to any component of the COVID-19 vaccine, that is to be administered in Stage 2, including polysorbate for participants receiving the Sanofi-GSK COVID-19 Vaccine, or to PEG.

a. 3 doses of the Pfizer-BioNTech COVID-19 Vaccine b. 3 doses of the Moderna COVID-19 Vaccine c. 2 doses of the Janssen COVID-19 Vaccine d. 4 doses of a combination of mRNA vaccines (i.e., Pfizer-BioNTech COVID-19 Vaccine, Moderna COVID-19 Vaccine)

General Pediatric Inclusion Criteria

Individuals 2-17 years of age that meet classification criteria for SLE, JIA, POMS, or JDM. Note: Juvenile idiopathic arthritis includes the following conditions: polyarticular JIA (both RF + and -), oligoarticular persistent and oligoarticular extended JIA, psoriatic arthritis, and enthesitis related JIA.
1. Participants must meet the 2017 EULAR/ACR classification criteria for adult and juvenile idiopathic inflammatory myopathies and their major subgroups, the International League of Associations for Rheumatology (ILAR) classification for JIA, the 2017 McDonald criteria for MS, or the Bohan and Peter criteria or the 2017 EULAR/ACR classification criteria for JDM.
2. If a participant has been diagnosed with more than one autoimmune disease, the participant will be assessed based on the disease that is selected for study entry.
Parents/guardians of all pediatric participants and participants ages 14 - 17 must be willing and able to sign informed consent. Participants ages 7-13 must be willing and able to sign assent.

5. Must be currently taking one of the following IS medications with or without additional disease-related medications: MMF (minimum of 250 mg per day)/MPA (minimum of 360 mg per day), MTX (minimum of 5 mg per week), or B cell depleting agents within the past 18 months (such as rituximab, ocrelizumab, or ofatumumab).

If taking MMF/MPA or MTX, the participant must have initiated therapy at least 8 weeks prior to randomization and be taking the same medications (regardless of dose) as at the time of the initial COVID-19 vaccine regimen. Note: Participants who withheld their IS medications around their initial vaccinations are eligible to participate.
If enrolling in the BCDT cohort, participant must have received an anti-CD20 or an anti-CD19 BCDT in the past 18 months.

6. No changes in background IS medications, including MMF/MPA or MTX, in the 8 weeks prior to Screening, excluding the following:

a. HCQ, b. Intraarticular steroids, c. The addition of prednisone at <0.15mg/kg/dose per day or prednisone at any dose when given for ≤3 days, and d. Corticosteroid bursts for non-autoimmune disease-related conditions, such as asthma or COPD, are permitted

General Pediatric Exclusion Criteria 1. Inability or unwillingness of a participant to give assent or of a parent/guardian to give written informed consent, or of either to comply with study protocol.

Pediatric Stage 1-Specific Inclusion Criteria:

4. Negative or suboptimal serologic response to initial EUA-authorized or FDA-approved COVID-19 vaccine doses, defined as an Elecsys® Anti-SARS-CoV-2 S result ≤200 U/mL, or a low immune response, defined as an Elecsys® Anti-SARS-CoV-2 S (RBD) result of ≤2500 U/mL, within 4 weeks of the Stage 1 Baseline/Week 0 visit

Initial COVID-19 vaccine regimen is defined as:

i. Pfizer-BioNTech COVID-19 Vaccine (2 through 4 years of age): 3 age-appropriate doses ii. Pfizer-BioNTech COVID-19 Vaccine (5 through 17 years of age): 2 age-appropriate doses iii. Moderna COVID-19 Vaccine (2 through 17 years of age): 2 age-appropriate doses.

Pediatric Stage 1-Specific Exclusion Criteria:

Individuals who meet any of these criteria are not eligible for randomization/allocation as participants in the pediatric portion of the study:

7. Receipt of a COVID-19 vaccine booster prior to Screening.

Pediatric Stage 2 (Newly Recruited)-Specific Inclusion Criteria 5. Negative or suboptimal serologic response to homologous doses of COVID-19 vaccine in one of the qualifying regimens, defined as an Elecsys® Anti-SARS-CoV-2 S (RBD) negative result or positive result of ≤200 U/mL, or a low immune response, defined as an Elecsys® Anti-SARS-CoV-2 S (RBD) result of ≤2500 U/mL, within 4 weeks of the Stage 2 Baseline/Week 0 visit. The regimens of COVID-19 vaccination that qualify are as follows: a. Pfizer-BioNTech COVID-19 Vaccine (2 through 5 years of age): 4 full, age-appropriate doses of the Pfizer-BioNTech COVID-19 Vaccine b. Pfizer-BioNTech COVID-19 Vaccine (5 through 17 years old): 3 full, age-appropriate doses of the Pfizer-BioNTech COVID-19 Vaccine Note: Participants who are 5 years old and previously received the Pfizer-BioNTech COVID-19 Vaccine may have received either age-appropriate regimen.

c. Moderna COVID-19 Vaccine (12 through 17 years of age): 3 full, age-appropriate doses of the Moderna COVID-19 Vaccine

Pediatric Stage 2 (Newly Recruited)-Specific Exclusion Criteria:

7. Receipt of an additional heterologous COVID-19 vaccine dose prior to Stage 2 Screening, i.e., a participant cannot have received a mixture of mRNA vaccines.

Pediatric Stage 2 (Rollover)-Specific Inclusion Criteria:

5. Negative or suboptimal serologic response to a previous COVID-19 vaccine administration in one of the qualifying regimens, defined as an Elecsys® Anti-SARS-CoV-2 S (RBD) negative result or positive result of ≤200 U/mL, or a low immune response, defined as an Elecsys® Anti-SARS-CoV-2 S (RBD) result of ≤2500 U/mL, within 4 weeks of the Stage 2 Baseline/Week 0 visit. The regimens of COVID-19 vaccination that qualify are as follows:

Pfizer-BioNTech COVID-19 Vaccine (2 through 5 years of age): 4 full, age-appropriate doses of the Pfizer-BioNTech COVID-19 Vaccine
Pfizer-BioNTech COVID-19 Vaccine (5 through 17 years old): 3 full, age-appropriate doses of the Pfizer-BioNTech COVID-19 Vaccine Note: Participants who are 5 years old and previously received the Pfizer-BioNTech COVID-19 Vaccine may have received either age-appropriate regimen.
Moderna COVID-19 Vaccine (12 through 17 years of age): 3 full, age-appropriate doses of the Moderna COVID-19 Vaccine

Name	Affiliation	Role
Judith A. James, MD, PhD	Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation	Study Chair
Meggan C. Mackay, MD, MS	Center of Autoimmune Musculoskeletal and Hematopoietic Diseases, Feinstein Institute for Medical Research	Study Chair
Dinesh Khanna, MBBS, MSc	University of Michigan Health, Michigan Medicine	Study Chair
Amit Bar-Or, MD, FRCP	Center for Neuroinflammation and Neurotherapeutics, Perelman School of Medicine, University of Pennsylvania	Study Chair
Virginia Pascual, MD	Drukier Institute for Children's Health, Weill Cornell Medical College	Study Chair
Stacy Ardoin, MD	Nationwide Children's Hospital Rheumatology Department	Study Chair
Natasha Mckerran Ruth, MD	Medical University of South Carolina, Pediatric Rheumatology	Study Chair
Tracey Wright, MD	UT Southwestern Medical Center, Pediatric Rheumatology	Study Chair

Facility	Status	City	State	ZIP	Country	Contacts
UCLA Medical Center: Division of Rheumatology		Los Angeles	California	90095	United States
Yale University School of Medicine: Rheumatology, Allergy & Immunology

PubMed Identifier	Type	Citation	Retractions
41289027	Derived	Mackay M, Wagner CA, Pinckney A, Cohen JA, Wallace ZS, Khosroshahi A, Sparks JA, Lord S, Saxena A, Caricchio R, Kim AH, Kamen DL, Koumpouras F, Askanase AD, Smith K, Guthridge JM, Pardo G, Mao-Draayer Y, Macwana S, McCarthy S, Sherman MA, Daneshfar Hamrah S, Veri M, Walker S, York K, Tedeschi SK, Wang J, Dziubla GE, Castro M, Carroll R, Narpala SR, Lin BC, Serebryannyy L, McDermott AB, Barry WT, Goldmuntz E, McNamara J, Payne AS, Bar-Or A, Khanna D, James JA. Prospective SARS-CoV-2 additional vaccination in immunosuppressant-treated individuals with autoimmune diseases in a randomized controlled trial. JCI Insight. 2025 Nov 25;11(1):e191266. doi: 10.1172/jci.insight.191266. Online ahead of print.

Label	URL
Autoimmunity Centers of Excellence (ACE)	View source

ID	Title	Description
FG000	Cohort A, Arm A1: Moderna mRNA-1273 + Continue IS (MMF or MPA)	Stage 1 adult participants who are taking mycophenolate mofetil (MMF) or mycophenolic acid (MPA) (without additional B cell depleting medications or methotrexate) for management of their underlying autoimmune disease will receive an additional dose of the Moderna mRNA-1273 COVID-19 vaccine and continue to take their immunosuppressive medications (IS) without alterations in schedule and dosing.

Type	Includes Protocol	Includes SAP	Includes ICF	Document Label	Document Date	Document Uploaded Date	Document File Name
Prot	Yes	No	No	Study Protocol	Dec 13, 2022	Feb 26, 2025

Arm/Group Information

ID	Title	Description
BG000	Cohort A, Arm A1: Moderna mRNA-1273 + Continue IS (MMF or MPA)	Stage 1 adult participants who are taking mycophenolate mofetil (MMF) or mycophenolic acid (MPA) (without additional B cell depleting medications or methotrexate) for management of their underlying autoimmune disease will receive an additional dose of the Moderna mRNA-1273 COVID-19 vaccine and continue to take their immunosuppressive medications (IS) without alterations in schedule and dosing.
BG001	Cohort A, Arm A4: Moderna mRNA-1273 + Withhold IS (MMF or MPA)	Stage 1 adult participants who are taking mycophenolate mofetil (MMF) or mycophenolic acid (MPA) (without additional B cell depleting medications or methotrexate) for management of their underlying autoimmune disease will withhold their cohort-defining immunosuppressive medications (IS) 3 days before and 10 days after receiving an additional dose of the Moderna mRNA-1273 COVID-19 vaccine, per protocol instruction. Participants taking additional IS medications (such as tumor necrosis factor [TNF] inhibitors, JAK inhibitors, abatacept, belimumab, etc.) will be required to continue them during the time of the additional vaccine dose.
BG002	Cohort A, Arm A2: Pfizer-BioNTech + Continue IS (MMF or MPA)	Stage 1 adult participants who are taking mycophenolate mofetil (MMF) or mycophenolic acid (MPA) (without additional B cell depleting medications or methotrexate) for management of their underlying autoimmune disease will receive an additional dose of the Pfizer-BioNTech (BNT162b2) COVID-19 vaccine and continue to take their immunosuppressive medications (IS) without alterations in schedule and dosing.
BG003	Cohort A, Arm A5: Pfizer-BioNTech + Withhold IS (MMF or MPA)	Stage 1 adult participants who are taking mycophenolate mofetil (MMF) or mycophenolic acid (MPA) (without additional B cell depleting medications or methotrexate) for management of their underlying autoimmune disease will withhold their cohort-defining immunosuppressive medications (IS) 3 days before and 10 days after receiving an additional dose of the Pfizer-BioNTech (BNT162b2) COVID-19 vaccine, per protocol instruction. Participants taking additional IS medications (such as tumor necrosis factor [TNF] inhibitors, JAK inhibitors, abatacept, belimumab, etc.) will be required to continue them during the time of the additional vaccine dose.
BG004	Cohort A, Arm A6: Janssen + Withhold IS (MMF or MPA)	Stage 1 adult participants who are taking mycophenolate mofetil (MMF) or mycophenolic acid (MPA) (without additional B cell depleting medications or methotrexate) for management of their underlying autoimmune disease will withhold their cohort-defining immunosuppressive medications (IS) 3 days before and 10 days after receiving an additional dose of the Ad26.COV2.S (Janssen) COVID-19 vaccine, per protocol instruction. Participants taking additional IS medications (such as tumor necrosis factor [TNF] inhibitors, JAK inhibitors, abatacept, belimumab, etc.) will be required to continue them during the time of the additional vaccine dose.
BG005	Cohort B, Arm B1: Moderna mRNA-1273 + Continue IS (MTX)	Stage 1 adult participants who are taking methotrexate (MTX) (without additional B cell depleting medications or mycophenolate mofetil or mycophenolic acid) for management of their underlying autoimmune disease will receive an additional dose of the Moderna mRNA-1273 COVID-19 vaccine and continue to take their immunosuppressive medications (IS) without alterations in schedule and dosing.
BG006	Cohort B, Arm B4: Moderna mRNA-1273 + Withhold IS (MTX)	Stage 1 adult participants who are taking methotrexate (MTX) (without additional B cell depleting medications or mycophenolate mofetil or mycophenolic acid) for management of their underlying autoimmune disease will withhold their cohort-defining immunosuppressive medications (IS) for at least 7 days before and at least 7 days after receiving an additional dose of the Moderna mRNA-1273 COVID-19 vaccine (but not for more than 21 days total), per protocol instruction. Participants taking additional IS medications (such as tumor necrosis factor [TNF] inhibitors, JAK inhibitors, abatacept, belimumab, etc.) will be required to continue them during the time of the additional vaccine dose.
BG007	Cohort B, Arm B2: Pfizer-BioNTech + Continue IS (MTX)	Stage 1 adult participants who are taking methotrexate (MTX) (without additional B cell depleting medications or mycophenolate mofetil or mycophenolic acid) for management of their underlying autoimmune disease will receive an additional dose of the Pfizer-BioNTech (BNT162b2) COVID-19 vaccine and continue to take their immunosuppressive medications (IS) without alterations in schedule and dosing.
BG008	Cohort B, Arm B5: Pfizer-BioNTech + Withhold IS (MTX)	Stage 1 adult participants who are taking methotrexate (MTX) (without additional B cell depleting medications or mycophenolate mofetil or mycophenolic acid) for management of their underlying autoimmune disease will withhold their cohort-defining immunosuppressive medications (IS) for at least 7 days before and at least 7 days after receiving an additional dose of the Pfizer-BioNTech (BNT162b2) COVID-19 vaccine (but not for more than 21 days total), per protocol instruction. Participants taking additional IS medications (such as tumor necrosis factor [TNF] inhibitors, JAK inhibitors, abatacept, belimumab, etc.) will be required to continue them during the time of the additional vaccine dose.
BG009	Cohort C, Arm C1: Moderna mRNA-1273 + Continue IS (BCDT)	Stage 1 adult participants taking B cell depletion therapy (BCDT) for management of their underlying autoimmune disease, regardless of whether they are also taking methotrexate, mycophenolate mofetil or mycophenolic acid, will receive an additional dose of the Moderna mRNA-1273 COVID-19 vaccine and continue to take their immunosuppressive medications (IS) without alterations in schedule and dosing.
BG010	Cohort C, Arm C2: Pfizer-BioNTech + Continue IS (BCDT)	Stage 1 adult participants taking B cell depletion therapy (BCDT) for management of their underlying autoimmune disease, regardless of whether they are also taking methotrexate, mycophenolate mofetil or mycophenolic acid, will receive an additional dose of the Pfizer-BioNTech (BNT162b2) COVID-19 vaccine and continue to take their immunosuppressive medications (IS) without alterations in schedule and dosing.
BG011	Cohort C, Arm C3: Janssen + Continue IS (BCDT)	Stage 1 adult participants taking B cell depletion therapy (BCDT) for management of their underlying autoimmune disease, regardless of whether they are also taking methotrexate, mycophenolate mofetil or mycophenolic acid, will receive an additional dose of the Ad26.COV2.S (Janssen) COVID-19 vaccine and continue to take their immunosuppressive medications (IS) without alterations in schedule and dosing.
BG012	Cohort D, Arm D2: Alternative mRNA + Withhold IS (MMF or MPA)	Stage 2 adult participants who previously received an mRNA vaccine and who are taking mycophenolate mofetil (MMF) or mycophenolic acid (MPA) (without additional B cell depleting medications or methotrexate) for management of their underlying autoimmune disease, will withhold their cohort-defining immunosuppressive medications (IS) 3 days before and 10 days after receiving a dose of an alternative COVID-19 vaccine (Moderna mRNA-1273 or Pfizer-BioNTech (BNT162b2)), per protocol instruction. Participants taking additional IS medications (such as tumor necrosis factor [TNF] inhibitors, JAK inhibitors, abatacept, belimumab, etc.) will be required to continue them during the time of the additional vaccine dose.
BG013	Cohort D, Arm D4: Sanofi-GSK + Withhold IS (MMF or MPA)	Stage 2 adult participants who previously received an mRNA vaccine and who are taking mycophenolate mofetil (MMF) or mycophenolic acid (MPA) (without additional B cell depleting medications or methotrexate) for management of their underlying autoimmune disease, will withhold their cohort-defining immunosuppressive medications (IS) 3 days before and 10 days after receiving a dose of the Sanofi-GSK (Monovalent [B.1.351] CoV2 preS dTM-AS03) COVID-19 vaccine, per protocol instruction. Participants taking additional IS medications (such as tumor necrosis factor [TNF] inhibitors, JAK inhibitors, abatacept, belimumab, etc.) will be required to continue them during the time of the additional vaccine dose
BG014	Cohort E, Arm E2: Alternative mRNA + Withhold IS (MTX)	Stage 2 adult participants who previously received an mRNA vaccine and who are taking methotrexate (MTX) (without additional B cell depleting medications or mycophenolate mofetil or mycophenolic acid) for management of their underlying autoimmune disease will withhold their cohort-defining immunosuppressive medications (IS) for at least 7 days before and at least 7 days after receiving a dose of an alternative COVID-19 vaccine (Moderna mRNA-1273 or Pfizer-BioNTech (BNT162b2)), but not for more than 21 days total, per protocol instruction. Participants taking additional IS medications (such as tumor necrosis factor [TNF] inhibitors, JAK inhibitors, abatacept, belimumab, etc.) will be required to continue them during the time of the additional vaccine dose.
BG015	Cohort E, Arm E4: Sanofi-GSK + Withhold IS (MTX)	Stage 2 adult participants who previously received an mRNA vaccine and who are taking methotrexate (MTX) (without additional B cell depleting medications or mycophenolate mofetil or mycophenolic acid) for management of their underlying autoimmune disease will withhold their cohort-defining immunosuppressive medications (IS) for at least 7 days before and at least 7 days after receiving a dose of the Sanofi-GSK (Monovalent [B.1.351] CoV2 preS dTM-AS03) vaccine, but not for more than 21 days total, per protocol instruction. Participants taking additional IS medications (such as tumor necrosis factor [TNF] inhibitors, JAK inhibitors, abatacept, belimumab, etc.) will be required to continue them during the time of the additional vaccine dose.
BG016	Cohort F, Arm F2: Alternative mRNA + Withhold IS (BCDT)	Stage 2 adult participants who previously received an mRNA COVID-19 vaccine and who are taking B cell depletion therapy (BCDT) for management of their underlying autoimmune disease, regardless of whether they are also taking methotrexate (MTX), mycophenolate mofetil (MMF) or mycophenolic acid (MPA), will continue to take their prescribed, cohort-defining, immunosuppressive medications (IS) without alterations in schedule and dosing. Participants who are taking MMF, MPA, or MTX in addition to BCDTs will withhold these medications (MMF, MPA, or MTX) before and after receiving a dose of the alternative COVID-19 vaccine (Moderna mRNA-1273 or Pfizer-BioNTech (BNT162b2)), per protocol instruction. MMF and MPA: hold 3 days before and 10 days after vaccine. MTX: hold for at least 7 days before and at least 7 days after vaccine, but not for more than 21 days total
BG017	Cohort F, Arm F3: Moderna mRNA-1273 + Withhold IS (BCDT)	Stage 2 adult participants who previously received the Janssen COVID-19 vaccine and who are taking B cell depletion therapy (BCDT) for management of their underlying autoimmune disease, regardless of whether they are also taking methotrexate (MTX), mycophenolate mofetil (MMF) or mycophenolic acid (MPA), will continue to take their prescribed, cohort-defining, immunosuppressive medications (IS) without alterations in schedule and dosing. Participants who are taking MMF, MPA, or MTX in addition to BCDTs will withhold these medications (MMF, MPA, or MTX) before and after receiving a dose of the Moderna mRNA-1273 vaccine, per protocol instruction. MMF and MPA: hold 3 days before and 10 days after vaccine. MTX: hold for at least 7 days before and at least 7 days after vaccine, but not for more than 21 days total.
BG018	Cohort F, Arm F4: Sanofi-GSK + Withhold IS (BCDT)	Stage 2 adult participants who previously received an mRNA COVID-19 vaccine and who are taking B cell depletion therapy (BCDT) for management of their underlying autoimmune disease, regardless of whether they are also taking methotrexate (MTX), mycophenolate mofetil (MMF) or mycophenolic acid (MPA), will continue to take their prescribed, cohort-defining, immunosuppressive medications (IS) without alterations in schedule and dosing. Participants who are taking MMF, MPA, or MTX in addition to BCDTs will withhold these medications (MMF, MPA, or MTX) before and after receiving a dose of the Sanofi-GSK (Monovalent [B.1.351] CoV2 preS dTM-AS03) vaccine, per protocol instruction. MMF and MPA: hold 3 days before and 10 days after vaccine. MTX: hold for at least 7 days before and at least 7 days after vaccine, but not for more than 21 days total.
BG019	Cohort F, Arm F1: Janssen + Withhold IS (BCDT)	Stage 2 adult participants who previously received an mRNA COVID-19 vaccine and who are taking B cell depletion therapy (BCDT) for management of their underlying autoimmune disease, regardless of whether they are also taking methotrexate (MTX), mycophenolate mofetil (MMF) or mycophenolic acid (MPA), will continue to take their prescribed, cohort-defining, immunosuppressive medications (IS) without alterations in schedule and dosing. Participants who are taking MMF, MPA, or MTX in addition to BCDTs will withhold these medications (MMF, MPA, or MTX) before and after receiving a dose of the Ad26.COV2.S (Janssen) vaccine, per protocol instruction. MMF and MPA: hold 3 days before and 10 days after vaccine. MTX: hold for at least 7 days before and at least 7 days after vaccine, but not for more than 21 days total.
BG020	Cohort D, Arm D2P: Moderna mRNA-1273 + Withhold IS (MMF/MPA)	Stage 2 pediatric participants who previously received the Pfizer-BioNTech COVID-19 vaccine and who are taking mycophenolate mofetil (MMF) or mycophenolic acid (MPA) (without additional B cell depleting medications or methotrexate) for management of their underlying autoimmune disease, will withhold their cohort-defining immunosuppressive medications (IS) 3 days before and 10 days after receiving a dose of the Moderna mRNA-1273 Bivalent COVID-19 vaccine, per protocol instruction. Participants taking additional IS medications (such as tumor necrosis factor [TNF] inhibitors, JAK inhibitors, abatacept, belimumab, etc.) will be required to continue them during the time of the additional vaccine dose.
BG021	Cohort E, Arm E2P: Moderna mRNA-1273 + Withhold IS (MTX)	Stage 2 pediatric participants who previously received the Pfizer-BioNTech COVID-19vaccine and who are taking methotrexate (MTX) (without additional B cell depleting medications or mycophenolate mofetil or mycophenolic acid) for management of their underlying autoimmune disease will withhold their cohort-defining immunosuppressive medications (IS) for at least 7 days before and at least 7 days after receiving a dose of the Moderna mRNA-1273 Bivalent vaccine, but not for more than 21 days total, per protocol instruction. Participants taking additional IS medications (such as tumor necrosis factor [TNF] inhibitors, JAK inhibitors, abatacept, belimumab, etc.) will be required to continue them during the time of the additional vaccine dose.
BG022	Total	Total of all reporting groups

Type

Title

Description

Population Description

Reporting Status

Anticipated Posting Date

Parameter Type

Dispersion Type

Unit of Measure

Calculate Percentage

Time Frame

Units Analyzed

Denominator Units Selected

Arm/Group Information

Denominators

Classes

Analyses

Primary

Percent of Stage 1 Adult Participants Who Have a Protective Antibody Response at Week 4

Antibody response was measured using the National Institute of Allergy and Infectious Disease Vaccine Research Center (NIAID-VRC) Meso Scale Discovery (MSD) 3 plex assay (Wu-1 full-length spike, receptor binding domain (RBD), and N proteins). A threshold for achieving a protective antibody response was not established for the NIAID VRC MSD assay. The intent was to use a pre-established threshold to define a protective antibody response. However, correlates from previous studies could not be extrapolated to the CoV-2 variants circulating over the entire course of this trial.

The vaccinated population includes all participants who were randomized or allocated and received study vaccine in the study.

Posted

Number

Percentage of participants

Week 4 Status Post Receipt of COVID-19 Vaccination

ID	Title	Description
OG000	Cohort A, Arm A1: Moderna mRNA-1273 + Continue IS (MMF or MPA)	Stage 1 adult participants who are taking mycophenolate mofetil (MMF) or mycophenolic acid (MPA) (without additional B cell depleting medications or methotrexate) for management of their underlying autoimmune disease will receive an additional dose of the Moderna mRNA-1273 COVID-19 vaccine and continue to take their immunosuppressive medications (IS) without alterations in schedule and dosing.
OG001	Cohort A, Arm A4: Moderna mRNA-1273 + Withhold IS (MMF or MPA)	Stage 1 adult participants who are taking mycophenolate mofetil (MMF) or mycophenolic acid (MPA) (without additional B cell depleting medications or methotrexate) for management of their underlying autoimmune disease will withhold their cohort-defining immunosuppressive medications (IS) 3 days before and 10 days after receiving an additional dose of the Moderna mRNA-1273 COVID-19 vaccine, per protocol instruction. Participants taking additional IS medications (such as tumor necrosis factor [TNF] inhibitors, JAK inhibitors, abatacept, belimumab, etc.) will be required to continue them during the time of the additional vaccine dose.
OG002	Cohort A, Arm A2: Pfizer-BioNTech + Continue IS (MMF or MPA)	Stage 1 adult participants who are taking mycophenolate mofetil (MMF) or mycophenolic acid (MPA) (without additional B cell depleting medications or methotrexate) for management of their underlying autoimmune disease will receive an additional dose of the Pfizer-BioNTech (BNT162b2) COVID-19 vaccine and continue to take their immunosuppressive medications (IS) without alterations in schedule and dosing.
OG003	Cohort A, Arm A5: Pfizer-BioNTech + Withhold IS (MMF or MPA)	Stage 1 adult participants who are taking mycophenolate mofetil (MMF) or mycophenolic acid (MPA) (without additional B cell depleting medications or methotrexate) for management of their underlying autoimmune disease will withhold their cohort-defining immunosuppressive medications (IS) 3 days before and 10 days after receiving an additional dose of the Pfizer-BioNTech (BNT162b2) COVID-19 vaccine, per protocol instruction. Participants taking additional IS medications (such as tumor necrosis factor [TNF] inhibitors, JAK inhibitors, abatacept, belimumab, etc.) will be required to continue them during the time of the additional vaccine dose.
OG004	Cohort A, Arm A6: Janssen + Withhold IS (MMF or MPA)	Stage 1 adult participants who are taking mycophenolate mofetil (MMF) or mycophenolic acid (MPA) (without additional B cell depleting medications or methotrexate) for management of their underlying autoimmune disease will withhold their cohort-defining immunosuppressive medications (IS) 3 days before and 10 days after receiving an additional dose of the Ad26.COV2.S (Janssen) COVID-19 vaccine, per protocol instruction. Participants taking additional IS medications (such as tumor necrosis factor [TNF] inhibitors, JAK inhibitors, abatacept, belimumab, etc.) will be required to continue them during the time of the additional vaccine dose.
OG005	Cohort B, Arm B1: Moderna mRNA-1273 + Continue IS (MTX)	Stage 1 adult participants who are taking methotrexate (MTX) (without additional B cell depleting medications or mycophenolate mofetil or mycophenolic acid) for management of their underlying autoimmune disease will receive an additional dose of the Moderna mRNA-1273 COVID-19 vaccine and continue to take their immunosuppressive medications (IS) without alterations in schedule and dosing.
OG006	Cohort B, Arm B4: Moderna mRNA-1273 + Withhold IS (MTX)	Stage 1 adult participants who are taking methotrexate (MTX) (without additional B cell depleting medications or mycophenolate mofetil or mycophenolic acid) for management of their underlying autoimmune disease will withhold their cohort-defining immunosuppressive medications (IS) for at least 7 days before and at least 7 days after receiving an additional dose of the Moderna mRNA-1273 COVID-19 vaccine (but not for more than 21 days total), per protocol instruction. Participants taking additional IS medications (such as tumor necrosis factor [TNF] inhibitors, JAK inhibitors, abatacept, belimumab, etc.) will be required to continue them during the time of the additional vaccine dose.
OG007	Cohort B, Arm B2: Pfizer-BioNTech + Continue IS (MTX)	Stage 1 adult participants who are taking methotrexate (MTX) (without additional B cell depleting medications or mycophenolate mofetil or mycophenolic acid) for management of their underlying autoimmune disease will receive an additional dose of the Pfizer-BioNTech (BNT162b2) COVID-19 vaccine and continue to take their immunosuppressive medications (IS) without alterations in schedule and dosing.
OG008	Cohort B, Arm B5: Pfizer-BioNTech + Withhold IS (MTX)	Stage 1 adult participants who are taking methotrexate (MTX) (without additional B cell depleting medications or mycophenolate mofetil or mycophenolic acid) for management of their underlying autoimmune disease will withhold their cohort-defining immunosuppressive medications (IS) for at least 7 days before and at least 7 days after receiving an additional dose of the Pfizer-BioNTech (BNT162b2) COVID-19 vaccine (but not for more than 21 days total), per protocol instruction. Participants taking additional IS medications (such as tumor necrosis factor [TNF] inhibitors, JAK inhibitors, abatacept, belimumab, etc.) will be required to continue them during the time of the additional vaccine dose.
OG009	Cohort C, Arm C1: Moderna mRNA-1273 + Continue IS (BCDT)	Stage 1 adult participants taking B cell depletion therapy (BCDT) for management of their underlying autoimmune disease, regardless of whether they are also taking methotrexate, mycophenolate mofetil or mycophenolic acid, will receive an additional dose of the Moderna mRNA-1273 COVID-19 vaccine and continue to take their immunosuppressive medications (IS) without alterations in schedule and dosing.
OG010	Cohort C, Arm C2: Pfizer-BioNTech + Continue IS (BCDT)	Stage 1 adult participants taking B cell depletion therapy (BCDT) for management of their underlying autoimmune disease, regardless of whether they are also taking methotrexate, mycophenolate mofetil or mycophenolic acid, will receive an additional dose of the Pfizer-BioNTech (BNT162b2) COVID-19 vaccine and continue to take their immunosuppressive medications (IS) without alterations in schedule and dosing.
OG011	Cohort C, Arm C3: Janssen + Continue IS (BCDT)	Stage 1 adult participants taking B cell depletion therapy (BCDT) for management of their underlying autoimmune disease, regardless of whether they are also taking methotrexate, mycophenolate mofetil or mycophenolic acid, will receive an additional dose of the Ad26.COV2.S (Janssen) COVID-19 vaccine and continue to take their immunosuppressive medications (IS) without alterations in schedule and dosing.

Units	Counts
Participants	OG0002 OG0011 OG0028 OG003

Title

Denominators

Categories

Week 4, Wu-1 Full-Length Spike

Title

Measurements

OG000NAThreshold for achieving a protective antibody response was not established for the NIAID VRC MSD assay. The intent was to use a pre-established threshold to define a protective antibody response. However, correlates from previous studies could not be extrapolated to the CoV-2 variants circulating over the entire course of this trial.
OG001NAThreshold for achieving a protective antibody response was not established for the NIAID VRC MSD assay. The intent was to use a pre-established threshold to define a protective antibody response. However, correlates from previous studies could not be extrapolated to the CoV-2 variants circulating over the entire course of this trial.
OG002

Primary

Percent of Stage 2 Adult Participants Who Have a Protective Antibody Response at Week 4

The vaccinated population includes all participants who were allocated and received study vaccine in the study.

Posted

Number

Percentage of participants

Week 4 Status Post Receipt of COVID-19 Vaccination

ID	Title	Description
OG000	Cohort D, Arm D2: Alternative mRNA + Withhold IS (MMF or MPA)	Stage 2 adult participants who previously received an mRNA vaccine and who are taking mycophenolate mofetil (MMF) or mycophenolic acid (MPA) (without additional B cell depleting medications or methotrexate) for management of their underlying autoimmune disease, will withhold their cohort-defining immunosuppressive medications (IS) 3 days before and 10 days after receiving a dose of an alternative COVID-19 vaccine (Moderna mRNA-1273 or Pfizer-BioNTech (BNT162b2)), per protocol instruction. Participants taking additional IS medications (such as tumor necrosis factor [TNF] inhibitors, JAK inhibitors, abatacept, belimumab, etc.) will be required to continue them during the time of the additional vaccine dose.

Primary

Percent of Stage 2 Pediatric Participants Who Have a Protective Antibody Response at Week 4

The vaccinated population includes all participants who were allocated and received study vaccine in the study.

Posted

Number

Percentage of participants

Week 4 Status Post Receipt of COVID-19 Vaccination

ID	Title	Description
OG000	Cohort D, Arm D2P: Moderna mRNA-1273 + Withhold IS (MMF/MPA)	Stage 2 pediatric participants who previously received the Pfizer-BioNTech COVID-19 vaccine and who are taking mycophenolate mofetil (MMF) or mycophenolic acid (MPA) (without additional B cell depleting medications or methotrexate) for management of their underlying autoimmune disease, will withhold their cohort-defining immunosuppressive medications (IS) 3 days before and 10 days after receiving a dose of the Moderna mRNA-1273 Bivalent COVID-19 vaccine, per protocol instruction. Participants taking additional IS medications (such as tumor necrosis factor [TNF] inhibitors, JAK inhibitors, abatacept, belimumab, etc.) will be required to continue them during the time of the additional vaccine dose.

Secondary

Percentage of Stage 1 Adult Participants Who Seroconverted

Antibody response was measured using the National Institute of Allergy and Infectious Disease Vaccine Research Center Meso Scale Discovery 3 plex assay. For concentrations below the lower limit of detection (LLOD), numeric values equivalent to LLOD/2 were assigned; concentrations above the upper limit of quantification were reported without adjustments. Antibody results collected after a documented COVID-19 infection, monoclonal antibody use, or COVID-19 vaccine given off-study were excluded from the analyses. Participants missing antibody data were considered missing-completely-at-random. Seroconversion was assessed in the subgroup of participants who were anti-COVID-19 antibody negative at Week 0; defined as a result less than or equal to the positive threshold value (spike=10.8424, RBD=14.0858). Anti-COVID-19 antibody negative at Week 0 is defined separately for spike and RBD. Seroconversion was defined as having a result greater than the positive threshold at the Week 4 visit.

The vaccinated population includes all participants who were randomized or allocated and received study vaccine in the study. Only participants who were anti-COVID-19 antibody negative (by either Wu-1 full-length spike or RBD) at Week 0 were included in the analysis.

Posted

Count of Participants

Participants

Week 4 Status Post Receipt of COVID-19 Vaccination

ID	Title	Description
OG000	Cohort A, Arm A1: Moderna mRNA-1273 + Continue IS (MMF or MPA)	Stage 1 adult participants who are taking mycophenolate mofetil (MMF) or mycophenolic acid (MPA) (without additional B cell depleting medications or methotrexate) for management of their underlying autoimmune disease will receive an additional dose of the Moderna mRNA-1273 COVID-19 vaccine and continue to take their immunosuppressive medications (IS) without alterations in schedule and dosing.

Secondary

Percentage of Stage 2 Adult Participants Who Seroconverted

The vaccinated population includes all participants who were randomized or allocated and received study vaccine in the study. Only participants who were anti-COVID-19 antibody negative (by Wu-1 full-length spike or RBD) at Week 0 were included in the analysis.

Posted

Count of Participants

Participants

Week 4 Status Post Receipt of COVID-19 Vaccination

ID	Title	Description
OG000	Cohort D, Arm D2: Alternative mRNA + Withhold IS (MMF or MPA)	Stage 2 adult participants who previously received an mRNA vaccine and who are taking mycophenolate mofetil (MMF) or mycophenolic acid (MPA) (without additional B cell depleting medications or methotrexate) for management of their underlying autoimmune disease, will withhold their cohort-defining immunosuppressive medications (IS) 3 days before and 10 days after receiving a dose of an alternative COVID-19 vaccine (Moderna mRNA-1273 or Pfizer-BioNTech (BNT162b2)), per protocol instruction. Participants taking additional IS medications (such as tumor necrosis factor [TNF] inhibitors, JAK inhibitors, abatacept, belimumab, etc.) will be required to continue them during the time of the additional vaccine dose.

Secondary

Fold Increase in Stage 1 Adult Anti-COVID-19 Antibody Levels

Antibody response was measured using the National Institute of Allergy and Infectious Disease Vaccine Research Center Meso Scale Discovery 3 plex assay. For concentrations below the lower limit of detection (LLOD), numeric values equivalent to LLOD/2 were assigned; concentrations above the upper limit of quantification were reported without adjustments. Antibody results collected after a documented COVID-19 infection, monoclonal antibody use, or a COVID-19 vaccine given off-study were excluded from the analyses. Participants with missing antibody data were considered missing-completely-at-random. Fold increase was assessed in the subgroup of participants who were anti-COVID-19 antibody positive at Week 0; defined as having a result greater than the positive threshold value (spike=10.8424, RBD=14.0858). Anti-COVID-19 antibody positive at Week 0 is defined separately for spike and RBD. Fold increase = (antibody response at Week 4)/(antibody response at Week 0).

The vaccinated population includes all participants who were randomized or allocated and received study vaccine in the study. Only participants who were anti-COVID-19 antibody positive (by Wu-1 full-length spike or RBD) at Week 0 were included in the analysis.

Posted

Geometric Mean

Geometric Coefficient of Variation

Fold Change

Week 4 Status Post Receipt of COVID-19 Vaccination

ID	Title	Description
OG000	Cohort A, Arm A1: Moderna mRNA-1273 + Continue IS (MMF or MPA)	Stage 1 adult participants who are taking mycophenolate mofetil (MMF) or mycophenolic acid (MPA) (without additional B cell depleting medications or methotrexate) for management of their underlying autoimmune disease will receive an additional dose of the Moderna mRNA-1273 COVID-19 vaccine and continue to take their immunosuppressive medications (IS) without alterations in schedule and dosing.

Secondary

Fold Increase in Stage 2 Adult Anti-COVID-19 Antibody Levels

Antibody response was measured using the National Institute of Allergy and Infectious Disease Vaccine Research Center Meso Scale Discovery 3 plex assay. For concentrations below the lower limit of detection (LLOD), numeric values equivalent to LLOD/2 were assigned; concentrations above the upper limit of quantification were reported without adjustments. Antibody results collected after a documented COVID-19 infection, monoclonal antibody use, or a COVID-19 vaccine given off-study were excluded from the analyses. Participants with missing antibody data were considered missing-completely-at-random. Fold increase was assessed in the subgroup of participants who were anti-COVID-19 antibody positive at Week 0; defined as having a result greater than the positive threshold value (spike=10.8424, RBD=14.0858). Anti-COVID-19 antibody positive at Week 0 is defined separately for spike and RBD. Fold increase = (antibody response at Week 4)/(antibody response at Week 0).

The vaccinated population includes all participants who were randomized or allocated and received study vaccine in the study. Only participants who were anti-COVID-19 antibody positive (by Wu-1 full-length spike or RBD) at Week 0 were included in the analysis.

Posted

Geometric Mean

Geometric Coefficient of Variation

Fold Change

Week 4 Status Post Receipt of COVID-19 Vaccination

ID	Title	Description
OG000	Cohort D, Arm D2: Alternative mRNA + Withhold IS (MMF or MPA)	Stage 2 adult participants who previously received an mRNA vaccine and who are taking mycophenolate mofetil (MMF) or mycophenolic acid (MPA) (without additional B cell depleting medications or methotrexate) for management of their underlying autoimmune disease, will withhold their cohort-defining immunosuppressive medications (IS) 3 days before and 10 days after receiving a dose of an alternative COVID-19 vaccine (Moderna mRNA-1273 or Pfizer-BioNTech (BNT162b2)), per protocol instruction. Participants taking additional IS medications (such as tumor necrosis factor [TNF] inhibitors, JAK inhibitors, abatacept, belimumab, etc.) will be required to continue them during the time of the additional vaccine dose.

Secondary

Change in Stage 1 Adult Anti-COVID-19 Antibody Response

Antibody response was measured using the National Institute of Allergy and Infectious Disease Vaccine Research Center (NIAID-VRC) Meso Scale Discovery (MSD) 3 plex assay (Wu-1 full-length spike, receptor binding domain (RBD), and N proteins). Wu-1 full-length spike and RBD were used to assess vaccine response. For concentrations below the lower limit of detection (LLOD), numeric values equivalent to LLOD/2 were assigned; concentrations above the upper limit of quantification were reported without adjustments. Antibody results collected after a documented COVID-19 infection, monoclonal antibody use, or a COVID-19 vaccine given off-study were excluded from the analyses. Participants with missing anti-COVID-19 antibody response data were considered to be missing-completely-at-random.

The vaccinated population includes all participants who were randomized or allocated and received study vaccine in the study.

Posted

Geometric Mean

Geometric Coefficient of Variation

IU/mL

Week 0 and Weeks 4 and 12 Status Post Receipt of COVID-19 Vaccination

ID	Title	Description
OG000	Cohort A, Arm A1: Moderna mRNA-1273 + Continue IS (MMF or MPA)	Stage 1 adult participants who are taking mycophenolate mofetil (MMF) or mycophenolic acid (MPA) (without additional B cell depleting medications or methotrexate) for management of their underlying autoimmune disease will receive an additional dose of the Moderna mRNA-1273 COVID-19 vaccine and continue to take their immunosuppressive medications (IS) without alterations in schedule and dosing.
OG001

Secondary

Change in Stage 2 Adult Anti-COVID-19 Antibody Response

Antibody response was measured using the National Institute of Allergy and Infectious Disease Vaccine Research Center (NIAID-VRC) Meso Scale Discovery (MSD) 3 plex assay (Wu-1 full-length spike, receptor binding domain (RBD), and N proteins). Wu-1 full-length spike and RBD were used to assess vaccine response. For concentrations below the lower limit of detection (LLOD), numeric values equivalent to LLOD/2 were assigned; concentrations above the upper limit of quantification were reported without adjustments. Antibody results collected after a documented COVID-19 infection, monoclonal antibody use, or a COVID-19 vaccine given off-study were excluded from the analyses. Participants with missing anti-COVID-19 antibody response data were considered to be missing-completely-at-random.

The vaccinated population includes all participants who were allocated and received study vaccine in the study.

Posted

Geometric Mean

Geometric Coefficient of Variation

IU/mL

Week 0 and Weeks 4 and 12 Status Post Receipt of COVID-19 Vaccination

ID	Title	Description
OG000	Cohort D, Arm D2: Alternative mRNA + Withhold IS (MMF or MPA)	Stage 2 adult participants who previously received an mRNA vaccine and who are taking mycophenolate mofetil (MMF) or mycophenolic acid (MPA) (without additional B cell depleting medications or methotrexate) for management of their underlying autoimmune disease, will withhold their cohort-defining immunosuppressive medications (IS) 3 days before and 10 days after receiving a dose of an alternative COVID-19 vaccine (Moderna mRNA-1273 or Pfizer-BioNTech (BNT162b2)), per protocol instruction. Participants taking additional IS medications (such as tumor necrosis factor [TNF] inhibitors, JAK inhibitors, abatacept, belimumab, etc.) will be required to continue them during the time of the additional vaccine dose.

Secondary

Fold Inhibition of ACE2 Binding to SARS-CoV-2 Variant Antigens by Stage 1 Adult Samples

Antibody response was measured using the National Institute of Allergy and Infectious Disease Vaccine Research Center (NIAID-VRC) Meso Scale Discovery (MSD) V-Plex ACE2 neutralization assay which measure antibodies that block the binding of angiotensin-converting enzyme 2 (ACE2) to the SARS-CoV-2 Spike antigens, including variants of the SARS-CoV-2 virus according to the manufacturer's instruction (MSD Catalog # K15654U). Antibody results collected after a documented COVID-19 infection, monoclonal antibody use, or a COVID-19 vaccine given off-study were excluded from the analyses. Participants with missing anti-COVID-19 antibody response data were considered to be missing-completely-at-random. Results are reported as fold inhibition by a sample relative to signal from a 'diluent only' control (maximum ACE2 binding to antigen). Highly neutralizing samples show high fold inhibition whereas negative or low samples show low fold inhibition of ACE2 binding.

The vaccinated population includes all participants who were randomized or allocated and received study vaccine in the study.

Posted

Geometric Mean

Geometric Coefficient of Variation

Fold Inhibition

Week 0 and Weeks 4 and 12 Status Post Receipt of COVID-19 Vaccination

ID	Title	Description
OG000	Cohort A, Arm A1: Moderna mRNA-1273 + Continue IS (MMF or MPA)	Stage 1 adult participants who are taking mycophenolate mofetil (MMF) or mycophenolic acid (MPA) (without additional B cell depleting medications or methotrexate) for management of their underlying autoimmune disease will receive an additional dose of the Moderna mRNA-1273 COVID-19 vaccine and continue to take their immunosuppressive medications (IS) without alterations in schedule and dosing.

Secondary

Fold Inhibition of ACE2 Binding to SARS-CoV-2 Variant Antigens by Stage 2 Adult Samples

The vaccinated population includes all participants who were allocated and received study vaccine in the study.

Posted

Geometric Mean

Geometric Coefficient of Variation

Fold Inhibition

Week 0 and Weeks 4 and 12 Status Post Receipt of COVID-19 Vaccination

ID	Title	Description
OG000	Cohort D, Arm D2: Alternative mRNA + Withhold IS (MMF or MPA)	Stage 2 adult participants who previously received an mRNA vaccine and who are taking mycophenolate mofetil (MMF) or mycophenolic acid (MPA) (without additional B cell depleting medications or methotrexate) for management of their underlying autoimmune disease, will withhold their cohort-defining immunosuppressive medications (IS) 3 days before and 10 days after receiving a dose of an alternative COVID-19 vaccine (Moderna mRNA-1273 or Pfizer-BioNTech (BNT162b2)), per protocol instruction. Participants taking additional IS medications (such as tumor necrosis factor [TNF] inhibitors, JAK inhibitors, abatacept, belimumab, etc.) will be required to continue them during the time of the additional vaccine dose.

Secondary

Change in Stage 1 Adult Disease Activity as Measured by the Clinical Global Impression of Change (CGI-C)

The Clinical Global Impression of Change (CGI-C) is the clinician's global impression of a participant's clinical condition in terms of change relative to the start of treatment. Change is rated on a 7-point scale from 1 (very much improved) to 7 (very much worse). Higher score = more affected.

The vaccinated population includes all participants who were randomized or allocated and received study vaccine in the study.

Posted

Count of Participants

Participants

Weeks 4 Status Post Receipt of COVID-19 Vaccine Dose

ID	Title	Description
OG000	Cohort A, Arm A1: Moderna mRNA-1273 + Continue IS (MMF or MPA)	Stage 1 adult participants who are taking mycophenolate mofetil (MMF) or mycophenolic acid (MPA) (without additional B cell depleting medications or methotrexate) for management of their underlying autoimmune disease will receive an additional dose of the Moderna mRNA-1273 COVID-19 vaccine and continue to take their immunosuppressive medications (IS) without alterations in schedule and dosing.
OG001	Cohort A, Arm A4: Moderna mRNA-1273 + Withhold IS (MMF or MPA)	Stage 1 adult participants who are taking mycophenolate mofetil (MMF) or mycophenolic acid (MPA) (without additional B cell depleting medications or methotrexate) for management of their underlying autoimmune disease will withhold their cohort-defining immunosuppressive medications (IS) 3 days before and 10 days after receiving an additional dose of the Moderna mRNA-1273 COVID-19 vaccine, per protocol instruction. Participants taking additional IS medications (such as tumor necrosis factor [TNF] inhibitors, JAK inhibitors, abatacept, belimumab, etc.) will be required to continue them during the time of the additional vaccine dose.

Secondary

Change in Stage 2 Adult Disease Activity After Receipt of Additional Doses of COVID-19 Vaccine as Measured by the Clinical Global Impression of Change (CGI-C)

The vaccinated population includes all participants who were allocated and received study vaccine in the study.

Posted

Count of Participants

Participants

Weeks 4 Status Post Receipt of COVID-19 Vaccine Dose

ID	Title	Description
OG000	Cohort D, Arm D2: Alternative mRNA + Withhold IS (MMF or MPA)	Stage 2 adult participants who previously received an mRNA vaccine and who are taking mycophenolate mofetil (MMF) or mycophenolic acid (MPA) (without additional B cell depleting medications or methotrexate) for management of their underlying autoimmune disease, will withhold their cohort-defining immunosuppressive medications (IS) 3 days before and 10 days after receiving a dose of an alternative COVID-19 vaccine (Moderna mRNA-1273 or Pfizer-BioNTech (BNT162b2)), per protocol instruction. Participants taking additional IS medications (such as tumor necrosis factor [TNF] inhibitors, JAK inhibitors, abatacept, belimumab, etc.) will be required to continue them during the time of the additional vaccine dose.
OG001	Cohort D, Arm D4: Sanofi-GSK + Withhold IS (MMF or MPA)

Secondary

Change in Adult Stage 1 Disease Activity as Measured by the Physician's Global Assessment

The Physician's Global Assessment of the participant's current disease activity is assessed on a 10 cm linear horizontal visual analog scale, where the left hand extreme of the line is considered "Very Good" (0 cm, no disease activity) and the right hand extreme is considered "Very Bad" (10 cm, severe disease activity).

The vaccinated population includes all participants who were randomized or allocated and received study vaccine in the study.

Posted

Mean

Standard Deviation

Baseline and Weeks 4, 12 Post Receipt of COVID-19 Vaccine Dose

ID	Title	Description
OG000	Cohort A, Arm A1: Moderna mRNA-1273 + Continue IS (MMF or MPA)	Stage 1 adult participants who are taking mycophenolate mofetil (MMF) or mycophenolic acid (MPA) (without additional B cell depleting medications or methotrexate) for management of their underlying autoimmune disease will receive an additional dose of the Moderna mRNA-1273 COVID-19 vaccine and continue to take their immunosuppressive medications (IS) without alterations in schedule and dosing.
OG001	Cohort A, Arm A4: Moderna mRNA-1273 + Withhold IS (MMF or MPA)	Stage 1 adult participants who are taking mycophenolate mofetil (MMF) or mycophenolic acid (MPA) (without additional B cell depleting medications or methotrexate) for management of their underlying autoimmune disease will withhold their cohort-defining immunosuppressive medications (IS) 3 days before and 10 days after receiving an additional dose of the Moderna mRNA-1273 COVID-19 vaccine, per protocol instruction. Participants taking additional IS medications (such as tumor necrosis factor [TNF] inhibitors, JAK inhibitors, abatacept, belimumab, etc.) will be required to continue them during the time of the additional vaccine dose.

Secondary

Change in Adult Stage 2 Disease Activity After Receipt of Additional Doses of COVID-19 Vaccine as Measured by the Physician's Global Assessment

The vaccinated population includes all participants who were allocated and received study vaccine in the study.

Posted

Mean

Standard Deviation

Baseline and Weeks 4, 12 Post Receipt of COVID-19 Vaccine Dose

ID	Title	Description
OG000	Cohort D, Arm D2: Alternative mRNA + Withhold IS (MMF or MPA)	Stage 2 adult participants who previously received an mRNA vaccine and who are taking mycophenolate mofetil (MMF) or mycophenolic acid (MPA) (without additional B cell depleting medications or methotrexate) for management of their underlying autoimmune disease, will withhold their cohort-defining immunosuppressive medications (IS) 3 days before and 10 days after receiving a dose of an alternative COVID-19 vaccine (Moderna mRNA-1273 or Pfizer-BioNTech (BNT162b2)), per protocol instruction. Participants taking additional IS medications (such as tumor necrosis factor [TNF] inhibitors, JAK inhibitors, abatacept, belimumab, etc.) will be required to continue them during the time of the additional vaccine dose.
OG001	Cohort D, Arm D4: Sanofi-GSK + Withhold IS (MMF or MPA)

Secondary

Change in Disease Activity in Stage 1 Adult Participants With Systemic Lupus Erythematosus (SLE) as Measured by Hybrid Systemic Lupus Erythematosus Disease Activity Index (hSLEDAI)

The Hybrid Systemic Lupus Erythematosus Disease Activity Index (hSLEDAI) is a validated, physician-based assessment tool used to measure the extent of lupus disease activity within the past 28 days. hSLEDAI total score is a weighted sum of the presence of 24 lupus disease symptoms and ranges from 0 to 105, with higher scores indicating more lupus disease activity present.

The vaccinated population includes all participants who were randomized or allocated and received study vaccine in the study. Only participants with Systemic Lupus Erythematosus (SLE) are included in the analysis.

Posted

Mean

Standard Deviation

hSLEDAI Score

Baseline and Weeks 4, 12 Post Receipt of COVID-19 Vaccine Dose

ID	Title	Description
OG000	Cohort A, Arm A1: Moderna mRNA-1273 + Continue IS (MMF or MPA)	Stage 1 adult participants who are taking mycophenolate mofetil (MMF) or mycophenolic acid (MPA) (without additional B cell depleting medications or methotrexate) for management of their underlying autoimmune disease will receive an additional dose of the Moderna mRNA-1273 COVID-19 vaccine and continue to take their immunosuppressive medications (IS) without alterations in schedule and dosing.
OG001	Cohort A, Arm A4: Moderna mRNA-1273 + Withhold IS (MMF or MPA)	Stage 1 adult participants who are taking mycophenolate mofetil (MMF) or mycophenolic acid (MPA) (without additional B cell depleting medications or methotrexate) for management of their underlying autoimmune disease will withhold their cohort-defining immunosuppressive medications (IS) 3 days before and 10 days after receiving an additional dose of the Moderna mRNA-1273 COVID-19 vaccine, per protocol instruction. Participants taking additional IS medications (such as tumor necrosis factor [TNF] inhibitors, JAK inhibitors, abatacept, belimumab, etc.) will be required to continue them during the time of the additional vaccine dose.

Secondary

Change in Disease Activity in Stage 2 Adult Participants With Systemic Lupus Erythematosus (SLE) as Measured by Hybrid Systemic Lupus Erythematosus Disease Activity Index (hSLEDAI)

Posted

Mean

Standard Deviation

hSLEDAI Score

Baseline and Weeks 4, 12 Post Receipt of COVID-19 Vaccine Dose

ID	Title	Description
OG000	Cohort D, Arm D2: Alternative mRNA + Withhold IS (MMF or MPA)	Stage 2 adult participants who previously received an mRNA vaccine and who are taking mycophenolate mofetil (MMF) or mycophenolic acid (MPA) (without additional B cell depleting medications or methotrexate) for management of their underlying autoimmune disease, will withhold their cohort-defining immunosuppressive medications (IS) 3 days before and 10 days after receiving a dose of an alternative COVID-19 vaccine (Moderna mRNA-1273 or Pfizer-BioNTech (BNT162b2)), per protocol instruction. Participants taking additional IS medications (such as tumor necrosis factor [TNF] inhibitors, JAK inhibitors, abatacept, belimumab, etc.) will be required to continue them during the time of the additional vaccine dose.

Secondary

Change in Disease Activity in Stage 1 Adult Participants With Systemic Lupus Erythematosus (SLE) as Measured by the Thanou Modified SELENA-SLEDAI Flare Index

The Thanou Modified Safety of Estrogens in Lupus Erythematosus: National Assessment- Hybrid Systemic Lupus Erythematosus Disease Activity Index (SELENA-SLEDAI) assesses systemic lupus erythematosus (SLE) disease activity and categorizes mild/moderate or severe flares based on changes in the SLEDAI score, the Physician's Global Assessment (PGA), other disease activity criteria, and hospitalization due to SLE. The hSLEDAI is a validated, physician-based assessment tool used to measure the extent of lupus disease activity within the past 28 days. hSLEDAI total score is a weighted sum of the presence of 24 lupus disease symptoms and ranges from 0 to 105, with higher scores indicating more lupus disease activity present.

Posted

Count of Participants

Participants

Baseline and Weeks 4, 12 Post Receipt of COVID-19 Vaccine Dose

ID	Title	Description
OG000	Cohort A, Arm A1: Moderna mRNA-1273 + Continue IS (MMF or MPA)	Stage 1 adult participants who are taking mycophenolate mofetil (MMF) or mycophenolic acid (MPA) (without additional B cell depleting medications or methotrexate) for management of their underlying autoimmune disease will receive an additional dose of the Moderna mRNA-1273 COVID-19 vaccine and continue to take their immunosuppressive medications (IS) without alterations in schedule and dosing.

Secondary

Change in Disease Activity in Stage 2 Adult Participants With Systemic Lupus Erythematosus (SLE) as Measured by the Thanou Modified SELENA-SLEDAI Flare Index

Posted

Count of Participants

Participants

Baseline and Weeks 4, 12 Post Receipt of COVID-19 Vaccine Dose

ID	Title	Description
OG000	Cohort D, Arm D2: Alternative mRNA + Withhold IS (MMF or MPA)	Stage 2 adult participants who previously received an mRNA vaccine and who are taking mycophenolate mofetil (MMF) or mycophenolic acid (MPA) (without additional B cell depleting medications or methotrexate) for management of their underlying autoimmune disease, will withhold their cohort-defining immunosuppressive medications (IS) 3 days before and 10 days after receiving a dose of an alternative COVID-19 vaccine (Moderna mRNA-1273 or Pfizer-BioNTech (BNT162b2)), per protocol instruction. Participants taking additional IS medications (such as tumor necrosis factor [TNF] inhibitors, JAK inhibitors, abatacept, belimumab, etc.) will be required to continue them during the time of the additional vaccine dose.

Secondary

Change in Disease Activity in Stage 1 Adult Participants With Rheumatoid Arthritis (RA) as Measured by Disease Activity Score 28 C-reactive Protein (DAS28-CRP)

The Disease Activity Score 28 C-reactive Protein (DAS28-CRP) is: a score on a scale (0 to 10) indicating current activity of rheumatoid arthritis (>5.1=high disease activity; <=3.2=low disease activity; <2.6=remission); a continuous variable which is a composite of 4 variables(the number of tender joints out of 28, the number of swollen joints out of 28 joints, serum C-reactive protein in mg/L (CRP) and subject assessment of disease activity measure on a visual analogue scale (VAS) of 100 mm). Reference: van Gestel AM et al. Arthritis Rheum.1998; 41(10): 1845-50.

The vaccinated population includes all participants who were randomized or allocated and received study vaccine in the study. Only participants with Rheumatoid Arthritis (RA) are included in the analysis.

Posted

Mean

Standard Deviation

DAS28-CRP Score

Baseline and Weeks 4, 12 Post Receipt of COVID-19 Vaccine Dose

ID	Title	Description
OG000	Cohort B, Arm B1: Moderna mRNA-1273 + Continue IS (MTX)	Stage 1 adult participants who are taking methotrexate (MTX) (without additional B cell depleting medications or mycophenolate mofetil or mycophenolic acid) for management of their underlying autoimmune disease will receive an additional dose of the Moderna mRNA-1273 COVID-19 vaccine and continue to take their immunosuppressive medications (IS) without alterations in schedule and dosing.
OG001	Cohort B, Arm B4: Moderna mRNA-1273 + Withhold IS (MTX)

Secondary

Change in Disease Activity in Stage 2 Adult Participants With Rheumatoid Arthritis (RA) as Measured by Disease Activity Score 28 C-reactive Protein (DAS28-CRP)

Posted

Mean

Standard Deviation

DAS28-CRP Score

Baseline and Weeks 4, 12 Post Receipt of COVID-19 Vaccine Dose

ID	Title	Description
OG000	Cohort E, Arm E2: Alternative mRNA + Withhold IS (MTX)	Stage 2 adult participants who previously received an mRNA vaccine and who are taking methotrexate (MTX) (without additional B cell depleting medications or mycophenolate mofetil or mycophenolic acid) for management of their underlying autoimmune disease will withhold their cohort-defining immunosuppressive medications (IS) for at least 7 days before and at least 7 days after receiving a dose of an alternative COVID-19 vaccine (Moderna mRNA-1273 or Pfizer-BioNTech (BNT162b2)), but not for more than 21 days total, per protocol instruction. Participants taking additional IS medications (such as tumor necrosis factor [TNF] inhibitors, JAK inhibitors, abatacept, belimumab, etc.) will be required to continue them during the time of the additional vaccine dose.

Secondary

Change in Disease Activity in Stage 1 Adult Participants With Systemic Sclerosis (SSc) as Measured by Disease Flare Activity

Severe disease flare included onset of new or significant worsening of internal organ involvement requiring hospitalization or change in treatment. Internal organ involvement included scleroderma renal crisis, interstitial lung disease, left or right sided heart failure, pulmonary arterial hypertension on right-sided heart catheterization or other worsening of internal organs.

The vaccinated population includes all participants who were randomized or allocated and received study vaccine in the study. Only participants with Systemic Sclerosis (SSc) are included in the analysis.

Posted

Count of Participants

Participants

Baseline and Weeks 4, 12 Post Receipt of COVID-19 Vaccine Dose

ID	Title	Description
OG000	Cohort A, Arm A1: Moderna mRNA-1273 + Continue IS (MMF or MPA)	Stage 1 adult participants who are taking mycophenolate mofetil (MMF) or mycophenolic acid (MPA) (without additional B cell depleting medications or methotrexate) for management of their underlying autoimmune disease will receive an additional dose of the Moderna mRNA-1273 COVID-19 vaccine and continue to take their immunosuppressive medications (IS) without alterations in schedule and dosing.
OG001	Cohort A, Arm A2: Pfizer-BioNTech + Continue IS (MMF or MPA)	Stage 1 adult participants who are taking mycophenolate mofetil (MMF) or mycophenolic acid (MPA) (without additional B cell depleting medications or methotrexate) for management of their underlying autoimmune disease will receive an additional dose of the Pfizer-BioNTech (BNT162b2) COVID-19 vaccine and continue to take their immunosuppressive medications (IS) without alterations in schedule and dosing.

Secondary

Change in Disease Activity in Stage 2 Adult Participants With Systemic Sclerosis (SSc) as Measured by Disease Flare Activity

Posted

Count of Participants

Participants

Baseline and Weeks 4, 12 Post Receipt of COVID-19 Vaccine Dose

ID	Title	Description
OG000	Cohort D, Arm D2: Alternative mRNA + Withhold IS (MMF or MPA)	Stage 2 adult participants who previously received an mRNA vaccine and who are taking mycophenolate mofetil (MMF) or mycophenolic acid (MPA) (without additional B cell depleting medications or methotrexate) for management of their underlying autoimmune disease, will withhold their cohort-defining immunosuppressive medications (IS) 3 days before and 10 days after receiving a dose of an alternative COVID-19 vaccine (Moderna mRNA-1273 or Pfizer-BioNTech (BNT162b2)), per protocol instruction. Participants taking additional IS medications (such as tumor necrosis factor [TNF] inhibitors, JAK inhibitors, abatacept, belimumab, etc.) will be required to continue them during the time of the additional vaccine dose.

Secondary

Change in Disease Activity in Stage 1 Adult Participants With Pemphigus as Measured by Disease Area Index (PDAI) for Pemphigus

The Pemphigus Disease Area Index (PDAI) was developed by the International Pemphigus Committee and measures both activity of and damage due to pemphigus on the skin, scalp, and mucous membranes. Total scores can range from 0 to a possible 263 maximum score, with 250 points representing disease activity (120 points for skin activity, 10 points for scalp activity, and 120 points for mucosal activity) and 13 points representing disease damage. Higher scores reflect worse disease.

The vaccinated population includes all participants who were randomized or allocated and received study vaccine in the study. Only participants with Pemphigus are included in the analysis.

Posted

Mean

Standard Deviation

PDAI Total Activity Score

Baseline and Weeks 4, 12 Post Receipt of COVID-19 Vaccine Dose

ID	Title	Description
OG000	Cohort A, Arm A5: Pfizer-BioNTech + Withhold IS (MMF or MPA)	Stage 1 adult participants who are taking mycophenolate mofetil (MMF) or mycophenolic acid (MPA) (without additional B cell depleting medications or methotrexate) for management of their underlying autoimmune disease will withhold their cohort-defining immunosuppressive medications (IS) 3 days before and 10 days after receiving an additional dose of the Pfizer-BioNTech (BNT162b2) COVID-19 vaccine, per protocol instruction. Participants taking additional IS medications (such as tumor necrosis factor [TNF] inhibitors, JAK inhibitors, abatacept, belimumab, etc.) will be required to continue them during the time of the additional vaccine dose.

Secondary

Change in Disease Activity in Stage 2 Adult Participants With Pemphigus as Measured by Disease Area Index (PDAI) for Pemphigus

The vaccinated population includes all participants who were randomized or allocated and received study vaccine in the study. Only participants with Pemphigus are included in the analysis.

Posted

Mean

Standard Deviation

PDAI Total Activity Score

Baseline and Weeks 4, 12 Post Receipt of COVID-19 Vaccine Dose

ID	Title	Description
OG000	Cohort F, Arm F2: Alternative mRNA + Withhold IS (BCDT)	Stage 2 adult participants who previously received an mRNA COVID-19 vaccine and who are taking B cell depletion therapy (BCDT) for management of their underlying autoimmune disease, regardless of whether they are also taking methotrexate (MTX), mycophenolate mofetil (MMF) or mycophenolic acid (MPA), will continue to take their prescribed, cohort-defining, immunosuppressive medications (IS) without alterations in schedule and dosing. Participants who are taking MMF, MPA, or MTX in addition to BCDTs will withhold these medications (MMF, MPA, or MTX) before and after receiving a dose of the alternative COVID-19 vaccine (Moderna mRNA-1273 or Pfizer-BioNTech (BNT162b2)), per protocol instruction. MMF and MPA: hold 3 days before and 10 days after vaccine. MTX: hold for at least 7 days before and at least 7 days after vaccine, but not for more than 21 days total

Secondary

Change in Disease Activity in Stage 1 Adult Participants With Multiple Sclerosis (MS) as Measured by Physician Assessed Relapse for MS

Relapse required: either criteria (a) with investigator determination of relapse or criteria (a) and (b): (a) New, recurrent or worsening neurological symptoms attributable to MS, that meet all of the following: i. Appeared or evolved subacutely (over <3 months). ii. Persisting >24 hours. iii. Can't be attributed to confounding factors. iv. Occur ≥30 days after onset of a prior confirmed relapse. (b) New, recurrent or worsening neurological symptoms accompanied by corresponding objective worsening on neurologic examination with an increase of any one of the following compared to the immediate prior assessment: i. ≥0.5 step(s) on the Expanded Disability Status Scale (EDSS), ii. ≥2 points on one Functional Systems Score (FSS), iii. ≥1 point on two or more FSS. Episodic spasms, sexual dysfunction, fatigue, mood change, or bladder/bowel urgency or incontinence will not suffice to establish relapse. Sexual dysfunction and fatigue will not contribute to the EDSS/FSS for assessing relapse.

The vaccinated population includes all participants who were randomized or allocated and received study vaccine in the study. Only participants with Multiple Sclerosis (MS) are included in the analysis.

Posted

Count of Participants

Participants

Screening and Weeks 4, 12 Post Receipt of COVID-19 Vaccine Dose

ID	Title	Description
OG000	Cohort C, Arm C1: Moderna mRNA-1273 + Continue IS (BCDT)	Stage 1 adult participants taking B cell depletion therapy (BCDT) for management of their underlying autoimmune disease, regardless of whether they are also taking methotrexate, mycophenolate mofetil or mycophenolic acid, will receive an additional dose of the Moderna mRNA-1273 COVID-19 vaccine and continue to take their immunosuppressive medications (IS) without alterations in schedule and dosing.

Secondary

Change in Disease Activity in Stage 2 Adult Participants With Multiple Sclerosis (MS) as Measured by Physician Assessed Relapse for MS

The vaccinated population includes all participants who were allocated and received study vaccine in the study. Only participants with Multiple Sclerosis (MS) are included in the analysis.

Posted

Count of Participants

Participants

Screening and Weeks 4, 12 Post Receipt of COVID-19 Vaccine Dose

ID	Title	Description
OG000	Cohort F, Arm F2: Alternative mRNA + Withhold IS (BCDT)	Stage 2 adult participants who previously received an mRNA COVID-19 vaccine and who are taking B cell depletion therapy (BCDT) for management of their underlying autoimmune disease, regardless of whether they are also taking methotrexate (MTX), mycophenolate mofetil (MMF) or mycophenolic acid (MPA), will continue to take their prescribed, cohort-defining, immunosuppressive medications (IS) without alterations in schedule and dosing. Participants who are taking MMF, MPA, or MTX in addition to BCDTs will withhold these medications (MMF, MPA, or MTX) before and after receiving a dose of the alternative COVID-19 vaccine (Moderna mRNA-1273 or Pfizer-BioNTech (BNT162b2)), per protocol instruction. MMF and MPA: hold 3 days before and 10 days after vaccine. MTX: hold for at least 7 days before and at least 7 days after vaccine, but not for more than 21 days total

Secondary

Change in Disease Activity in Stage 2 Pediatric Participants With Juvenile Idiopathic Arthritis (JIA) as Measured by the Juvenile Arthritis Disease Activity Score 10 (JADAS10)

The Juvenile Arthritis Disease Activity Score 10-C-reactive Protein (JADAS10-CRP) is a score on a scale (0 to 40) indicating activity of juvenile idiopathic arthritis. Total active joints are scored 0 to 10, with an active joint count >10 scored as 10 points. The Physician's Global Assessment and Patient's Global Assessment are measured on a 0-10 scale (0 cm, no disease activity to 10 cm, worst disease activity). CRP is normalized to a 0 to 10 scale according to the following formula: (CRP (mg/L) - 10)/10. CRP values <10 mg/L are scored as 0, and CRP >110 mg/L are scored as 10. The final score is given by the simple sum of its component. Higher scores indicate worse disease activity.

The vaccinated population includes all participants who were allocated and received study vaccine in the study. Only participants with Juvenile Idiopathic Arthritis (JIA) are included in the analysis.

Posted

Mean

Standard Deviation

JADAS10 Score

Baseline and Weeks 4, 12 Post Receipt of COVID-19 Vaccine Dose

ID	Title	Description
OG000	Cohort E, Arm E2P: Moderna mRNA-1273 + Withhold IS (MTX)	Stage 2 pediatric participants who previously received the Pfizer-BioNTech COVID-19vaccine and who are taking methotrexate (MTX) (without additional B cell depleting medications or mycophenolate mofetil or mycophenolic acid) for management of their underlying autoimmune disease will withhold their cohort-defining immunosuppressive medications (IS) for at least 7 days before and at least 7 days after receiving a dose of the Moderna mRNA-1273 Bivalent vaccine, but not for more than 21 days total, per protocol instruction. Participants taking additional IS medications (such as tumor necrosis factor [TNF] inhibitors, JAK inhibitors, abatacept, belimumab, etc.) will be required to continue them during the time of the additional vaccine dose.

Secondary

Change in Adult Stage 1 Disease Activity as Measured by the Patient-Reported Outcomes Measurement Information System (PROMIS-29)

The Patient-Reported Outcomes Measurement Information System (PROMIS)-29 Short Form (Version 2.0) will be used to assess trends over time in this state of health measure. The PROMIS-29 consists of 7 domains related to physical, mental and social health. Raw scores are calculated for each domain and translated into a T-score per the PROMIS-29 scoring guide. The T-score rescales the raw score into a standardized score with a mean of 50 and a standard deviation of 10. Physical Function domain score is presented. A higher score represents better functioning for the Physical Function domain.

The vaccinated population includes all participants who were randomized or allocated and received study vaccine in the study.

Posted

Mean

Standard Deviation

T-Score

Baseline and Weeks 4, 12 Post Receipt of COVID-19 Vaccine Dose

ID	Title	Description
OG000	Cohort A, Arm A1: Moderna mRNA-1273 + Continue IS (MMF or MPA)	Stage 1 adult participants who are taking mycophenolate mofetil (MMF) or mycophenolic acid (MPA) (without additional B cell depleting medications or methotrexate) for management of their underlying autoimmune disease will receive an additional dose of the Moderna mRNA-1273 COVID-19 vaccine and continue to take their immunosuppressive medications (IS) without alterations in schedule and dosing.
OG001	Cohort A, Arm A4: Moderna mRNA-1273 + Withhold IS (MMF or MPA)

Secondary

Change in Adult Stage 2 Disease Activity as Measured by the Patient-Reported Outcomes Measurement Information System (PROMIS-29)

The vaccinated population includes all participants who were allocated and received study vaccine in the study.

Posted

Mean

Standard Deviation

T-Score

Baseline and Weeks 4, 12 Post Receipt of COVID-19 Vaccine Dose

ID	Title	Description
OG000	Cohort D, Arm D2: Alternative mRNA + Withhold IS (MMF or MPA)	Stage 2 adult participants who previously received an mRNA vaccine and who are taking mycophenolate mofetil (MMF) or mycophenolic acid (MPA) (without additional B cell depleting medications or methotrexate) for management of their underlying autoimmune disease, will withhold their cohort-defining immunosuppressive medications (IS) 3 days before and 10 days after receiving a dose of an alternative COVID-19 vaccine (Moderna mRNA-1273 or Pfizer-BioNTech (BNT162b2)), per protocol instruction. Participants taking additional IS medications (such as tumor necrosis factor [TNF] inhibitors, JAK inhibitors, abatacept, belimumab, etc.) will be required to continue them during the time of the additional vaccine dose.

Secondary

Change in Adult Stage 1 Disease Activity as Measured by the Patient Global Assessment

The Patient Global Assessment of the participant's current disease activity is assessed on a 10 cm linear horizontal visual analog scale, where the left hand extreme of the line is considered "Very Good" (0 cm, no disease activity) and the right hand extreme is considered "Very Bad" (10 cm, severe disease activity).

The vaccinated population includes all participants who were randomized or allocated and received study vaccine in the study.

Posted

Mean

Standard Deviation

Baseline and Weeks 4, 12 Post Receipt of COVID-19 Vaccine Dose

ID	Title	Description
OG000	Cohort A, Arm A1: Moderna mRNA-1273 + Continue IS (MMF or MPA)	Stage 1 adult participants who are taking mycophenolate mofetil (MMF) or mycophenolic acid (MPA) (without additional B cell depleting medications or methotrexate) for management of their underlying autoimmune disease will receive an additional dose of the Moderna mRNA-1273 COVID-19 vaccine and continue to take their immunosuppressive medications (IS) without alterations in schedule and dosing.
OG001	Cohort A, Arm A4: Moderna mRNA-1273 + Withhold IS (MMF or MPA)	Stage 1 adult participants who are taking mycophenolate mofetil (MMF) or mycophenolic acid (MPA) (without additional B cell depleting medications or methotrexate) for management of their underlying autoimmune disease will withhold their cohort-defining immunosuppressive medications (IS) 3 days before and 10 days after receiving an additional dose of the Moderna mRNA-1273 COVID-19 vaccine, per protocol instruction. Participants taking additional IS medications (such as tumor necrosis factor [TNF] inhibitors, JAK inhibitors, abatacept, belimumab, etc.) will be required to continue them during the time of the additional vaccine dose.

Secondary

Change in Adult Stage 2 Disease Activity as Measured by the Patient Global Assessment

The vaccinated population includes all participants who were allocated and received study vaccine in the study.

Posted

Mean

Standard Deviation

Baseline and Weeks 4, 12 Post Receipt of COVID-19 Vaccine Dose

ID	Title	Description
OG000	Cohort D, Arm D2: Alternative mRNA + Withhold IS (MMF or MPA)	Stage 2 adult participants who previously received an mRNA vaccine and who are taking mycophenolate mofetil (MMF) or mycophenolic acid (MPA) (without additional B cell depleting medications or methotrexate) for management of their underlying autoimmune disease, will withhold their cohort-defining immunosuppressive medications (IS) 3 days before and 10 days after receiving a dose of an alternative COVID-19 vaccine (Moderna mRNA-1273 or Pfizer-BioNTech (BNT162b2)), per protocol instruction. Participants taking additional IS medications (such as tumor necrosis factor [TNF] inhibitors, JAK inhibitors, abatacept, belimumab, etc.) will be required to continue them during the time of the additional vaccine dose.
OG001	Cohort D, Arm D4: Sanofi-GSK + Withhold IS (MMF or MPA)

Secondary

Change in Stage 1 Adult Disease Activity as Measured by the Patient Global Impression of Change (PGI-C)

The Patient Global Impression of Change (PGI-C) is the participant's global impression of their clinical condition in terms of change relative to the start of treatment. Change is rated on a 7-point scale from 1 (very much improved) to 7 (very much worse). Higher score = more affected.

The vaccinated population includes all participants who were randomized or allocated and received study vaccine in the study.

Posted

Count of Participants

Participants

Weeks 4 Status Post Receipt of COVID-19 Vaccine Dose

ID	Title	Description
OG000	Cohort A, Arm A1: Moderna mRNA-1273 + Continue IS (MMF or MPA)	Stage 1 adult participants who are taking mycophenolate mofetil (MMF) or mycophenolic acid (MPA) (without additional B cell depleting medications or methotrexate) for management of their underlying autoimmune disease will receive an additional dose of the Moderna mRNA-1273 COVID-19 vaccine and continue to take their immunosuppressive medications (IS) without alterations in schedule and dosing.
OG001	Cohort A, Arm A4: Moderna mRNA-1273 + Withhold IS (MMF or MPA)	Stage 1 adult participants who are taking mycophenolate mofetil (MMF) or mycophenolic acid (MPA) (without additional B cell depleting medications or methotrexate) for management of their underlying autoimmune disease will withhold their cohort-defining immunosuppressive medications (IS) 3 days before and 10 days after receiving an additional dose of the Moderna mRNA-1273 COVID-19 vaccine, per protocol instruction. Participants taking additional IS medications (such as tumor necrosis factor [TNF] inhibitors, JAK inhibitors, abatacept, belimumab, etc.) will be required to continue them during the time of the additional vaccine dose.

Secondary

Change in Stage 2 Adult Disease Activity as Measured by the Patient Global Impression of Change (PGI-C)

The vaccinated population includes all participants who were allocated and received study vaccine in the study.

Posted

Count of Participants

Participants

Weeks 4 Status Post Receipt of COVID-19 Vaccine Dose

ID	Title	Description
OG000	Cohort D, Arm D2: Alternative mRNA + Withhold IS (MMF or MPA)	Stage 2 adult participants who previously received an mRNA vaccine and who are taking mycophenolate mofetil (MMF) or mycophenolic acid (MPA) (without additional B cell depleting medications or methotrexate) for management of their underlying autoimmune disease, will withhold their cohort-defining immunosuppressive medications (IS) 3 days before and 10 days after receiving a dose of an alternative COVID-19 vaccine (Moderna mRNA-1273 or Pfizer-BioNTech (BNT162b2)), per protocol instruction. Participants taking additional IS medications (such as tumor necrosis factor [TNF] inhibitors, JAK inhibitors, abatacept, belimumab, etc.) will be required to continue them during the time of the additional vaccine dose.
OG001	Cohort D, Arm D4: Sanofi-GSK + Withhold IS (MMF or MPA)

Secondary

Percent of Stage 1 Adult Participants Who Experience Any Grade 1 or Higher Adverse Events Related to Study Vaccine

All unsolicited adverse events (AEs) (all grades) were collected from Day 1 through Day 28; solicited AEs were collected if they were ongoing at Day 7 (post vaccination); any flares of a secondary autoimmune disease, serious AEs, medically attended AEs, new onset chronic medical conditions, and COVID-19 infections were collected from Day 1 through the end of the participant's study participation. All AEs were classified by system organ class (SOC) and preferred term, according to a standardized thesaurus (Medical Dictionary for Regulatory Activities [MedDRA] version 24.0. Related AEs were defined as "possibly related" (the AE has a reasonable possibility to be related; there is evidence to suggest a causal relationship) or "related" (the adverse event is clearly related). Severity was assessed according to the criteria set forth in the National Cancer Institute's Common Terminology Criteria for Adverse Events (CTCAE) 5.0.

The vaccinated population includes all participants who were randomized or allocated and received study vaccine in the study.

Posted

Count of Participants

Participants

Up to Week 48 post study vaccination

ID	Title	Description
OG000	Cohort A, Arm A1: Moderna mRNA-1273 + Continue IS (MMF or MPA)	Stage 1 adult participants who are taking mycophenolate mofetil (MMF) or mycophenolic acid (MPA) (without additional B cell depleting medications or methotrexate) for management of their underlying autoimmune disease will receive an additional dose of the Moderna mRNA-1273 COVID-19 vaccine and continue to take their immunosuppressive medications (IS) without alterations in schedule and dosing.

Secondary

Percent of Stage 2 Adult Participants Who Experience Any Grade 1 or Higher Adverse Events Related to Study Vaccine

The vaccinated population includes all participants who were allocated and received study vaccine in the study.

Posted

Count of Participants

Participants

Up to Week 48 post study vaccination

ID	Title	Description
OG000	Cohort D, Arm D2: Alternative mRNA + Withhold IS (MMF or MPA)	Stage 2 adult participants who previously received an mRNA vaccine and who are taking mycophenolate mofetil (MMF) or mycophenolic acid (MPA) (without additional B cell depleting medications or methotrexate) for management of their underlying autoimmune disease, will withhold their cohort-defining immunosuppressive medications (IS) 3 days before and 10 days after receiving a dose of an alternative COVID-19 vaccine (Moderna mRNA-1273 or Pfizer-BioNTech (BNT162b2)), per protocol instruction. Participants taking additional IS medications (such as tumor necrosis factor [TNF] inhibitors, JAK inhibitors, abatacept, belimumab, etc.) will be required to continue them during the time of the additional vaccine dose.

Secondary

Percent of Stage 1 Adult Participants Who Experience Any Serious Adverse Events (SAEs)

An event is considered "serious" if, in the view of either the investigator or Sponsor, it results in any of the following: 1. Death. 2. Life-threatening event: considered "life-threatening" if, in the view of either the investigator or Sponsor, its occurrence places the participant at immediate risk of death. It does not include an AE that, had it occurred in a more severe form, might have caused death. 3. Inpatient hospitalization or prolongation of existing hospitalization. 4. Persistent or significant incapacity or substantial disruption of the ability to conduct normal life functions. 5. Congenital anomaly or birth defect. 6. Important medical events that may not result in death, be life threatening, or require hospitalization may be considered serious when, based upon appropriate medical judgment, they may jeopardize the participant and may require medical or surgical intervention to prevent one of the outcomes listed above.

The vaccinated population includes all participants who were randomized or allocated and received study vaccine in the study.

Posted

Count of Participants

Participants

Up to Week 48 post study vaccination

ID	Title	Description
OG000	Cohort A, Arm A1: Moderna mRNA-1273 + Continue IS (MMF or MPA)	Stage 1 adult participants who are taking mycophenolate mofetil (MMF) or mycophenolic acid (MPA) (without additional B cell depleting medications or methotrexate) for management of their underlying autoimmune disease will receive an additional dose of the Moderna mRNA-1273 COVID-19 vaccine and continue to take their immunosuppressive medications (IS) without alterations in schedule and dosing.

Secondary

Percent of Stage 2 Adult Participants Who Experience Any Serious Adverse Events (SAEs)

The vaccinated population includes all participants who were allocated and received study vaccine in the study.

Posted

Count of Participants

Participants

Up to Week 48 post study vaccination

ID	Title	Description
OG000	Cohort D, Arm D2: Alternative mRNA + Withhold IS (MMF or MPA)	Stage 2 adult participants who previously received an mRNA vaccine and who are taking mycophenolate mofetil (MMF) or mycophenolic acid (MPA) (without additional B cell depleting medications or methotrexate) for management of their underlying autoimmune disease, will withhold their cohort-defining immunosuppressive medications (IS) 3 days before and 10 days after receiving a dose of an alternative COVID-19 vaccine (Moderna mRNA-1273 or Pfizer-BioNTech (BNT162b2)), per protocol instruction. Participants taking additional IS medications (such as tumor necrosis factor [TNF] inhibitors, JAK inhibitors, abatacept, belimumab, etc.) will be required to continue them during the time of the additional vaccine dose.

Secondary

Percent of Stage 1 Adult Participants Who Experience Any Medically Attended Adverse Events (MAAEs)

Medically attended adverse event (MAAE) is defined as a hospitalization, emergency room visit, or an otherwise unscheduled visit to or from medical personnel for any reason that is considered possibly related or related to study vaccine.

The vaccinated population includes all participants who were randomized or allocated and received study vaccine in the study.

Posted

Count of Participants

Participants

Up to Week 48 post study vaccination

ID	Title	Description
OG000	Cohort A, Arm A1: Moderna mRNA-1273 + Continue IS (MMF or MPA)	Stage 1 adult participants who are taking mycophenolate mofetil (MMF) or mycophenolic acid (MPA) (without additional B cell depleting medications or methotrexate) for management of their underlying autoimmune disease will receive an additional dose of the Moderna mRNA-1273 COVID-19 vaccine and continue to take their immunosuppressive medications (IS) without alterations in schedule and dosing.
OG001	Cohort A, Arm A4: Moderna mRNA-1273 + Withhold IS (MMF or MPA)	Stage 1 adult participants who are taking mycophenolate mofetil (MMF) or mycophenolic acid (MPA) (without additional B cell depleting medications or methotrexate) for management of their underlying autoimmune disease will withhold their cohort-defining immunosuppressive medications (IS) 3 days before and 10 days after receiving an additional dose of the Moderna mRNA-1273 COVID-19 vaccine, per protocol instruction. Participants taking additional IS medications (such as tumor necrosis factor [TNF] inhibitors, JAK inhibitors, abatacept, belimumab, etc.) will be required to continue them during the time of the additional vaccine dose.

Secondary

Percent of Stage 2 Adult Participants Who Experience Any Medically Attended Adverse Events (MAAEs)

The vaccinated population includes all participants who were allocated and received study vaccine in the study.

Posted

Count of Participants

Participants

Up to Week 48 post study vaccination

ID	Title	Description
OG000	Cohort D, Arm D2: Alternative mRNA + Withhold IS (MMF or MPA)	Stage 2 adult participants who previously received an mRNA vaccine and who are taking mycophenolate mofetil (MMF) or mycophenolic acid (MPA) (without additional B cell depleting medications or methotrexate) for management of their underlying autoimmune disease, will withhold their cohort-defining immunosuppressive medications (IS) 3 days before and 10 days after receiving a dose of an alternative COVID-19 vaccine (Moderna mRNA-1273 or Pfizer-BioNTech (BNT162b2)), per protocol instruction. Participants taking additional IS medications (such as tumor necrosis factor [TNF] inhibitors, JAK inhibitors, abatacept, belimumab, etc.) will be required to continue them during the time of the additional vaccine dose.
OG001	Cohort D, Arm D4: Sanofi-GSK + Withhold IS (MMF or MPA)	Stage 2 adult participants who previously received an mRNA vaccine and who are taking mycophenolate mofetil (MMF) or mycophenolic acid (MPA) (without additional B cell depleting medications or methotrexate) for management of their underlying autoimmune disease, will withhold their cohort-defining immunosuppressive medications (IS) 3 days before and 10 days after receiving a dose of the Sanofi-GSK (Monovalent [B.1.351] CoV2 preS dTM-AS03) COVID-19 vaccine, per protocol instruction. Participants taking additional IS medications (such as tumor necrosis factor [TNF] inhibitors, JAK inhibitors, abatacept, belimumab, etc.) will be required to continue them during the time of the additional vaccine dose

Secondary

Percent of Stage 1 Adult Participants Who Experience Any New Onset Chronic Medical Conditions (NOCMCs)

A new onset chronic medical condition (NOCMC) is defined as any new ICD diagnosis (per current International Statistical Classification of Diseases and Related Health Problems) that is applied to the study participant during the course of the study, after receipt of the vaccine, that is expected to continue for at least 3 months and requires continued health care intervention.

The vaccinated population includes all participants who were randomized or allocated and received study vaccine in the study.

Posted

Count of Participants

Participants

Up to Week 48 post study vaccination

ID	Title	Description
OG000	Cohort A, Arm A1: Moderna mRNA-1273 + Continue IS (MMF or MPA)	Stage 1 adult participants who are taking mycophenolate mofetil (MMF) or mycophenolic acid (MPA) (without additional B cell depleting medications or methotrexate) for management of their underlying autoimmune disease will receive an additional dose of the Moderna mRNA-1273 COVID-19 vaccine and continue to take their immunosuppressive medications (IS) without alterations in schedule and dosing.
OG001	Cohort A, Arm A4: Moderna mRNA-1273 + Withhold IS (MMF or MPA)	Stage 1 adult participants who are taking mycophenolate mofetil (MMF) or mycophenolic acid (MPA) (without additional B cell depleting medications or methotrexate) for management of their underlying autoimmune disease will withhold their cohort-defining immunosuppressive medications (IS) 3 days before and 10 days after receiving an additional dose of the Moderna mRNA-1273 COVID-19 vaccine, per protocol instruction. Participants taking additional IS medications (such as tumor necrosis factor [TNF] inhibitors, JAK inhibitors, abatacept, belimumab, etc.) will be required to continue them during the time of the additional vaccine dose.

Secondary

Percent of Stage 2 Adult Participants Who Experience Any New Onset Chronic Medical Conditions (NOCMCs)

The vaccinated population includes all participants who were allocated and received study vaccine in the study.

Posted

Count of Participants

Participants

Up to Week 48 post study vaccination

ID	Title	Description
OG000	Cohort D, Arm D2: Alternative mRNA + Withhold IS (MMF or MPA)	Stage 2 adult participants who previously received an mRNA vaccine and who are taking mycophenolate mofetil (MMF) or mycophenolic acid (MPA) (without additional B cell depleting medications or methotrexate) for management of their underlying autoimmune disease, will withhold their cohort-defining immunosuppressive medications (IS) 3 days before and 10 days after receiving a dose of an alternative COVID-19 vaccine (Moderna mRNA-1273 or Pfizer-BioNTech (BNT162b2)), per protocol instruction. Participants taking additional IS medications (such as tumor necrosis factor [TNF] inhibitors, JAK inhibitors, abatacept, belimumab, etc.) will be required to continue them during the time of the additional vaccine dose.
OG001	Cohort D, Arm D4: Sanofi-GSK + Withhold IS (MMF or MPA)

Secondary

Percent of Stage 1 Adult Participants Who Experience Any Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) Infection

Efficacy measure.

The vaccinated population includes all participants who were randomized or allocated and received study vaccine in the study.

Posted

Count of Participants

Participants

Up to Week 48 post study vaccination

ID	Title	Description
OG000	Cohort A, Arm A1: Moderna mRNA-1273 + Continue IS (MMF or MPA)	Stage 1 adult participants who are taking mycophenolate mofetil (MMF) or mycophenolic acid (MPA) (without additional B cell depleting medications or methotrexate) for management of their underlying autoimmune disease will receive an additional dose of the Moderna mRNA-1273 COVID-19 vaccine and continue to take their immunosuppressive medications (IS) without alterations in schedule and dosing.
OG001	Cohort A, Arm A4: Moderna mRNA-1273 + Withhold IS (MMF or MPA)	Stage 1 adult participants who are taking mycophenolate mofetil (MMF) or mycophenolic acid (MPA) (without additional B cell depleting medications or methotrexate) for management of their underlying autoimmune disease will withhold their cohort-defining immunosuppressive medications (IS) 3 days before and 10 days after receiving an additional dose of the Moderna mRNA-1273 COVID-19 vaccine, per protocol instruction. Participants taking additional IS medications (such as tumor necrosis factor [TNF] inhibitors, JAK inhibitors, abatacept, belimumab, etc.) will be required to continue them during the time of the additional vaccine dose.

Secondary

Percent of Stage 2 Adult Participants Who Experience Any Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) Infection

COVID-19 infections (all grades) were confirmed by molecular COVID-19 testing. AEs were classified by system organ class and preferred term according to the Medical Dictionary for Regulatory Activities (MedDRA) version 24.0.

The vaccinated population includes all participants who were allocated and received study vaccine in the study.

Posted

Count of Participants

Participants

Up to Week 48 post study vaccination

ID	Title	Description
OG000	Cohort D, Arm D2: Alternative mRNA + Withhold IS (MMF or MPA)	Stage 2 adult participants who previously received an mRNA vaccine and who are taking mycophenolate mofetil (MMF) or mycophenolic acid (MPA) (without additional B cell depleting medications or methotrexate) for management of their underlying autoimmune disease, will withhold their cohort-defining immunosuppressive medications (IS) 3 days before and 10 days after receiving a dose of an alternative COVID-19 vaccine (Moderna mRNA-1273 or Pfizer-BioNTech (BNT162b2)), per protocol instruction. Participants taking additional IS medications (such as tumor necrosis factor [TNF] inhibitors, JAK inhibitors, abatacept, belimumab, etc.) will be required to continue them during the time of the additional vaccine dose.
OG001	Cohort D, Arm D4: Sanofi-GSK + Withhold IS (MMF or MPA)	Stage 2 adult participants who previously received an mRNA vaccine and who are taking mycophenolate mofetil (MMF) or mycophenolic acid (MPA) (without additional B cell depleting medications or methotrexate) for management of their underlying autoimmune disease, will withhold their cohort-defining immunosuppressive medications (IS) 3 days before and 10 days after receiving a dose of the Sanofi-GSK (Monovalent [B.1.351] CoV2 preS dTM-AS03) COVID-19 vaccine, per protocol instruction. Participants taking additional IS medications (such as tumor necrosis factor [TNF] inhibitors, JAK inhibitors, abatacept, belimumab, etc.) will be required to continue them during the time of the additional vaccine dose

Secondary

Percentage of Stage 2 Pediatric Participants Who Seroconverted

Antibody response was measured using the National Institute of Allergy and Infectious Disease Vaccine Research Center Meso Scale Discovery 3 plex assay. For concentrations below the lower limit of detection (LLOD), numeric values equivalent to LLOD/2 were assigned; concentrations above the upper limit of quantification were reported without adjustments. Antibody results collected after a documented COVID-19 infection, monoclonal antibody use, or a COVID-19 vaccine given off-study were excluded from the analyses. Participants with missing antibody data were considered missing-completely-at-random. Seroconversion was assessed in the subgroup of participants who were anti-COVID-19 antibody negative at Week 0; defined as a result less than or equal to the positive threshold value (spike=10.8424, RBD=14.0858), defined independently for spike and RBD. Seroconversion was defined as having a result greater than the positive threshold at the Week 4 visit.

The vaccinated population includes all participants who were allocated and received study vaccine in the study. Only participants who were anti-COVID-19 antibody negative at Week 0 were included in the analysis.

Posted

Count of Participants

Participants

Week 4 Status Post Receipt of COVID-19 Vaccination

ID	Title	Description
OG000	Cohort D, Arm D2P: Moderna mRNA-1273 + Withhold IS (MMF/MPA)	Stage 2 pediatric participants who previously received the Pfizer-BioNTech COVID-19 vaccine and who are taking mycophenolate mofetil (MMF) or mycophenolic acid (MPA) (without additional B cell depleting medications or methotrexate) for management of their underlying autoimmune disease, will withhold their cohort-defining immunosuppressive medications (IS) 3 days before and 10 days after receiving a dose of the Moderna mRNA-1273 Bivalent COVID-19 vaccine, per protocol instruction. Participants taking additional IS medications (such as tumor necrosis factor [TNF] inhibitors, JAK inhibitors, abatacept, belimumab, etc.) will be required to continue them during the time of the additional vaccine dose.

Secondary

Fold Increase in Stage 2 Pediatric Anti-COVID-19 Antibody Levels

Antibody response was measured using the National Institute of Allergy and Infectious Disease Vaccine Research Center Meso Scale Discovery 3 plex assay. For concentrations below the lower limit of detection (LLOD), numeric values equivalent to LLOD/2 were assigned; concentrations above the upper limit of quantification were reported without adjustments. Antibody results collected after a documented COVID-19 infection, monoclonal antibody use, or a COVID-19 vaccine given off-study were excluded from the analyses. Participants with missing antibody data were considered missing-completely-at-random. Fold increase was assessed in the subgroup of participants who were anti-COVID-19 antibody positive at Week 0; defined as having a result greater than the positive threshold value (spike=10.8424, RBD=14.0858), defined independently for spike and RBD. Fold increase = (antibody response at Week 4)/(antibody response at Week 0).

The vaccinated population includes all participants who were allocated and received study vaccine in the study. Only participants who were anti-COVID-19 antibody positive at Week 0 were included in the analysis.

Posted

Geometric Mean

Geometric Coefficient of Variation

Fold Change

Week 4 Status Post Receipt of COVID-19 Vaccination

ID	Title	Description
OG000	Cohort E, Arm E2P: Moderna mRNA-1273 + Withhold IS (MTX)	Stage 2 pediatric participants who previously received the Pfizer-BioNTech COVID-19vaccine and who are taking methotrexate (MTX) (without additional B cell depleting medications or mycophenolate mofetil or mycophenolic acid) for management of their underlying autoimmune disease will withhold their cohort-defining immunosuppressive medications (IS) for at least 7 days before and at least 7 days after receiving a dose of the Moderna mRNA-1273 Bivalent vaccine, but not for more than 21 days total, per protocol instruction. Participants taking additional IS medications (such as tumor necrosis factor [TNF] inhibitors, JAK inhibitors, abatacept, belimumab, etc.) will be required to continue them during the time of the additional vaccine dose.

Secondary

Change in Stage 2 Pediatric Anti-COVID-19 Antibody Response

Antibody response was measured using the National Institute of Allergy and Infectious Disease Vaccine Research Center (NIAID-VRC) Meso Scale Discovery (MSD) 3 plex assay (Wu-1 full-length spike, receptor binding domain (RBD), and N proteins). Wu-1 full-length spike and RBD were used to assess vaccine response. For concentrations below the lower limit of detection (LLOD), numeric values equivalent to LLOD/2 were assigned; concentrations above the upper limit of quantification were reported without adjustments. Antibody results collected after a documented COVID-19 infection, monoclonal antibody use, or a COVID-19 vaccine given off-study were excluded from the analyses. Participants with missing anti-COVID-19 antibody response data were considered to be missing-completely-at-random.

The vaccinated population includes all participants who were allocated and received study vaccine in the study.

Posted

Geometric Mean

Geometric Coefficient of Variation

IU/mL

Week 0 and Weeks 4 and 12 Status Post Receipt of COVID-19 Vaccination

ID	Title	Description
OG000	Cohort D, Arm D2P: Moderna mRNA-1273 + Withhold IS (MMF/MPA)	Stage 2 pediatric participants who previously received the Pfizer-BioNTech COVID-19 vaccine and who are taking mycophenolate mofetil (MMF) or mycophenolic acid (MPA) (without additional B cell depleting medications or methotrexate) for management of their underlying autoimmune disease, will withhold their cohort-defining immunosuppressive medications (IS) 3 days before and 10 days after receiving a dose of the Moderna mRNA-1273 Bivalent COVID-19 vaccine, per protocol instruction. Participants taking additional IS medications (such as tumor necrosis factor [TNF] inhibitors, JAK inhibitors, abatacept, belimumab, etc.) will be required to continue them during the time of the additional vaccine dose.

Secondary

Fold Inhibition of ACE2 Binding to SARS-CoV-2 Variant Antigens by Stage 2 Pediatric Samples

The vaccinated population includes all participants who were allocated and received study vaccine in the study.

Posted

Geometric Mean

Geometric Coefficient of Variation

Fold Inhibition

Week 0 and Weeks 4 and 12 Status Post Receipt of COVID-19 Vaccination

ID	Title	Description
OG000	Cohort D, Arm D2P: Moderna mRNA-1273 + Withhold IS (MMF/MPA)	Stage 2 pediatric participants who previously received the Pfizer-BioNTech COVID-19 vaccine and who are taking mycophenolate mofetil (MMF) or mycophenolic acid (MPA) (without additional B cell depleting medications or methotrexate) for management of their underlying autoimmune disease, will withhold their cohort-defining immunosuppressive medications (IS) 3 days before and 10 days after receiving a dose of the Moderna mRNA-1273 Bivalent COVID-19 vaccine, per protocol instruction. Participants taking additional IS medications (such as tumor necrosis factor [TNF] inhibitors, JAK inhibitors, abatacept, belimumab, etc.) will be required to continue them during the time of the additional vaccine dose.

Secondary

Change in Stage 2 Pediatric Disease Activity After Receipt of Additional Doses of COVID-19 Vaccine as Measured by the Clinical Global Impression of Change (CGI-C)

The vaccinated population includes all participants who were allocated and received study vaccine in the study.

Posted

Count of Participants

Participants

Weeks 4 Status Post Receipt of COVID-19 Vaccine Dose

ID	Title	Description
OG000	Cohort D, Arm D2P: Moderna mRNA-1273 + Withhold IS (MMF/MPA)	Stage 2 pediatric participants who previously received the Pfizer-BioNTech COVID-19 vaccine and who are taking mycophenolate mofetil (MMF) or mycophenolic acid (MPA) (without additional B cell depleting medications or methotrexate) for management of their underlying autoimmune disease, will withhold their cohort-defining immunosuppressive medications (IS) 3 days before and 10 days after receiving a dose of the Moderna mRNA-1273 Bivalent COVID-19 vaccine, per protocol instruction. Participants taking additional IS medications (such as tumor necrosis factor [TNF] inhibitors, JAK inhibitors, abatacept, belimumab, etc.) will be required to continue them during the time of the additional vaccine dose.
OG001	Cohort E, Arm E2P: Moderna mRNA-1273 + Withhold IS (MTX)

Secondary

Change in Pediatric Stage 2 Disease Activity After Receipt of Additional Doses of COVID-19 Vaccine as Measured by the Physician's Global Assessment

The vaccinated population includes all participants who were allocated and received study vaccine in the study.

Posted

Mean

Standard Deviation

Baseline and Weeks 4, 12 Post Receipt of COVID-19 Vaccine Dose

ID	Title	Description
OG000	Cohort D, Arm D2P: Moderna mRNA-1273 + Withhold IS (MMF/MPA)	Stage 2 pediatric participants who previously received the Pfizer-BioNTech COVID-19 vaccine and who are taking mycophenolate mofetil (MMF) or mycophenolic acid (MPA) (without additional B cell depleting medications or methotrexate) for management of their underlying autoimmune disease, will withhold their cohort-defining immunosuppressive medications (IS) 3 days before and 10 days after receiving a dose of the Moderna mRNA-1273 Bivalent COVID-19 vaccine, per protocol instruction. Participants taking additional IS medications (such as tumor necrosis factor [TNF] inhibitors, JAK inhibitors, abatacept, belimumab, etc.) will be required to continue them during the time of the additional vaccine dose.
OG001	Cohort E, Arm E2P: Moderna mRNA-1273 + Withhold IS (MTX)

Secondary

Change in Disease Activity in Stage 2 Pediatric Participants With Systemic Lupus Erythematosus (SLE) as Measured by Systemic Lupus Erythematosus Disease Activity Index (SLEDAI)-2K

The Systemic Lupus Erythematosus Disease Activity Index (SLEDAI)-2K is a validated, physician-based assessment tool used to measure the extent of lupus disease activity within the past 28 days. SLEDAI-2K total score is a weighted sum of the presence of 24 lupus disease symptoms and ranges from 0 to 105, with higher scores indicating more lupus disease activity present.

The vaccinated population includes all participants who were allocated and received study vaccine in the study. Only participants with Systemic Lupus Erythematosus (SLE) are included in the analysis.

Posted

Mean

Standard Deviation

SLEDAI-2K Score

Baseline and Weeks 4, 12 Post Receipt of COVID-19 Vaccine Dose

ID	Title	Description
OG000	Cohort D, Arm D2P: Moderna mRNA-1273 + Withhold IS (MMF/MPA)	Stage 2 pediatric participants who previously received the Pfizer-BioNTech COVID-19 vaccine and who are taking mycophenolate mofetil (MMF) or mycophenolic acid (MPA) (without additional B cell depleting medications or methotrexate) for management of their underlying autoimmune disease, will withhold their cohort-defining immunosuppressive medications (IS) 3 days before and 10 days after receiving a dose of the Moderna mRNA-1273 Bivalent COVID-19 vaccine, per protocol instruction. Participants taking additional IS medications (such as tumor necrosis factor [TNF] inhibitors, JAK inhibitors, abatacept, belimumab, etc.) will be required to continue them during the time of the additional vaccine dose.

Secondary

Change in Pediatric Stage 2 Disease Activity as Measured by the Patient Global Assessment

The vaccinated population includes all participants who were allocated and received study vaccine in the study.

Posted

Mean

Standard Deviation

Baseline and Weeks 4, 12 Post Receipt of COVID-19 Vaccine Dose

ID	Title	Description
OG000	Cohort D, Arm D2P: Moderna mRNA-1273 + Withhold IS (MMF/MPA)	Stage 2 pediatric participants who previously received the Pfizer-BioNTech COVID-19 vaccine and who are taking mycophenolate mofetil (MMF) or mycophenolic acid (MPA) (without additional B cell depleting medications or methotrexate) for management of their underlying autoimmune disease, will withhold their cohort-defining immunosuppressive medications (IS) 3 days before and 10 days after receiving a dose of the Moderna mRNA-1273 Bivalent COVID-19 vaccine, per protocol instruction. Participants taking additional IS medications (such as tumor necrosis factor [TNF] inhibitors, JAK inhibitors, abatacept, belimumab, etc.) will be required to continue them during the time of the additional vaccine dose.
OG001	Cohort E, Arm E2P: Moderna mRNA-1273 + Withhold IS (MTX)

Secondary

Change in Stage 2 Pediatric Disease Activity as Measured by the Patient Global Impression of Change (PGI-C)

The vaccinated population includes all participants who were allocated and received study vaccine in the study.

Posted

Count of Participants

Participants

Weeks 4 Status Post Receipt of COVID-19 Vaccine Dose

ID	Title	Description
OG000	Cohort D, Arm D2P: Moderna mRNA-1273 + Withhold IS (MMF/MPA)	Stage 2 pediatric participants who previously received the Pfizer-BioNTech COVID-19 vaccine and who are taking mycophenolate mofetil (MMF) or mycophenolic acid (MPA) (without additional B cell depleting medications or methotrexate) for management of their underlying autoimmune disease, will withhold their cohort-defining immunosuppressive medications (IS) 3 days before and 10 days after receiving a dose of the Moderna mRNA-1273 Bivalent COVID-19 vaccine, per protocol instruction. Participants taking additional IS medications (such as tumor necrosis factor [TNF] inhibitors, JAK inhibitors, abatacept, belimumab, etc.) will be required to continue them during the time of the additional vaccine dose.
OG001	Cohort E, Arm E2P: Moderna mRNA-1273 + Withhold IS (MTX)

Secondary

Percent of Stage 2 Pediatric Participants Who Experience Any Grade 1 or Higher Adverse Events Related to Study Vaccine

The vaccinated population includes all participants who were allocated and received study vaccine in the study.

Posted

Count of Participants

Participants

Up to Week 48 post study vaccination

ID	Title	Description
OG000	Cohort D, Arm D2P: Moderna mRNA-1273 + Withhold IS (MMF/MPA)	Stage 2 pediatric participants who previously received the Pfizer-BioNTech COVID-19 vaccine and who are taking mycophenolate mofetil (MMF) or mycophenolic acid (MPA) (without additional B cell depleting medications or methotrexate) for management of their underlying autoimmune disease, will withhold their cohort-defining immunosuppressive medications (IS) 3 days before and 10 days after receiving a dose of the Moderna mRNA-1273 Bivalent COVID-19 vaccine, per protocol instruction. Participants taking additional IS medications (such as tumor necrosis factor [TNF] inhibitors, JAK inhibitors, abatacept, belimumab, etc.) will be required to continue them during the time of the additional vaccine dose.

Secondary

Percent of Stage 2 Pediatric Participants Who Experience Any Serious Adverse Events (SAEs)

The vaccinated population includes all participants who were allocated and received study vaccine in the study.

Posted

Count of Participants

Participants

Up to Week 48 post study vaccination

ID	Title	Description
OG000	Cohort D, Arm D2P: Moderna mRNA-1273 + Withhold IS (MMF/MPA)	Stage 2 pediatric participants who previously received the Pfizer-BioNTech COVID-19 vaccine and who are taking mycophenolate mofetil (MMF) or mycophenolic acid (MPA) (without additional B cell depleting medications or methotrexate) for management of their underlying autoimmune disease, will withhold their cohort-defining immunosuppressive medications (IS) 3 days before and 10 days after receiving a dose of the Moderna mRNA-1273 Bivalent COVID-19 vaccine, per protocol instruction. Participants taking additional IS medications (such as tumor necrosis factor [TNF] inhibitors, JAK inhibitors, abatacept, belimumab, etc.) will be required to continue them during the time of the additional vaccine dose.

Secondary

Percent of Stage 2 Pediatric Participants Who Experience Any Medically Attended Adverse Events (MAAEs)

The vaccinated population includes all participants who were allocated and received study vaccine in the study.

Posted

Count of Participants

Participants

Up to Week 48 post study vaccination

ID	Title	Description
OG000	Cohort D, Arm D2P: Moderna mRNA-1273 + Withhold IS (MMF/MPA)	Stage 2 pediatric participants who previously received the Pfizer-BioNTech COVID-19 vaccine and who are taking mycophenolate mofetil (MMF) or mycophenolic acid (MPA) (without additional B cell depleting medications or methotrexate) for management of their underlying autoimmune disease, will withhold their cohort-defining immunosuppressive medications (IS) 3 days before and 10 days after receiving a dose of the Moderna mRNA-1273 Bivalent COVID-19 vaccine, per protocol instruction. Participants taking additional IS medications (such as tumor necrosis factor [TNF] inhibitors, JAK inhibitors, abatacept, belimumab, etc.) will be required to continue them during the time of the additional vaccine dose.
OG001	Cohort E, Arm E2P: Moderna mRNA-1273 + Withhold IS (MTX)	Stage 2 pediatric participants who previously received the Pfizer-BioNTech COVID-19vaccine and who are taking methotrexate (MTX) (without additional B cell depleting medications or mycophenolate mofetil or mycophenolic acid) for management of their underlying autoimmune disease will withhold their cohort-defining immunosuppressive medications (IS) for at least 7 days before and at least 7 days after receiving a dose of the Moderna mRNA-1273 Bivalent vaccine, but not for more than 21 days total, per protocol instruction. Participants taking additional IS medications (such as tumor necrosis factor [TNF] inhibitors, JAK inhibitors, abatacept, belimumab, etc.) will be required to continue them during the time of the additional vaccine dose.

Secondary

Percent of Stage 2 Pediatric Participants Who Experience Any New Onset Chronic Medical Conditions (NOCMCs)

The vaccinated population includes all participants who were allocated and received study vaccine in the study.

Posted

Count of Participants

Participants

Up to Week 48 post study vaccination

ID	Title	Description
OG000	Cohort D, Arm D2P: Moderna mRNA-1273 + Withhold IS (MMF/MPA)	Stage 2 pediatric participants who previously received the Pfizer-BioNTech COVID-19 vaccine and who are taking mycophenolate mofetil (MMF) or mycophenolic acid (MPA) (without additional B cell depleting medications or methotrexate) for management of their underlying autoimmune disease, will withhold their cohort-defining immunosuppressive medications (IS) 3 days before and 10 days after receiving a dose of the Moderna mRNA-1273 Bivalent COVID-19 vaccine, per protocol instruction. Participants taking additional IS medications (such as tumor necrosis factor [TNF] inhibitors, JAK inhibitors, abatacept, belimumab, etc.) will be required to continue them during the time of the additional vaccine dose.
OG001	Cohort E, Arm E2P: Moderna mRNA-1273 + Withhold IS (MTX)

Secondary

Percent of Stage 2 Pediatric Participants Who Experience Any Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) Infection

The vaccinated population includes all participants who were allocated and received study vaccine in the study.

Posted

Count of Participants

Participants

Up to Week 48 post study vaccination

ID	Title	Description
OG000	Cohort D, Arm D2P: Moderna mRNA-1273 + Withhold IS (MMF/MPA)	Stage 2 pediatric participants who previously received the Pfizer-BioNTech COVID-19 vaccine and who are taking mycophenolate mofetil (MMF) or mycophenolic acid (MPA) (without additional B cell depleting medications or methotrexate) for management of their underlying autoimmune disease, will withhold their cohort-defining immunosuppressive medications (IS) 3 days before and 10 days after receiving a dose of the Moderna mRNA-1273 Bivalent COVID-19 vaccine, per protocol instruction. Participants taking additional IS medications (such as tumor necrosis factor [TNF] inhibitors, JAK inhibitors, abatacept, belimumab, etc.) will be required to continue them during the time of the additional vaccine dose.
OG001	Cohort E, Arm E2P: Moderna mRNA-1273 + Withhold IS (MTX)	Stage 2 pediatric participants who previously received the Pfizer-BioNTech COVID-19vaccine and who are taking methotrexate (MTX) (without additional B cell depleting medications or mycophenolate mofetil or mycophenolic acid) for management of their underlying autoimmune disease will withhold their cohort-defining immunosuppressive medications (IS) for at least 7 days before and at least 7 days after receiving a dose of the Moderna mRNA-1273 Bivalent vaccine, but not for more than 21 days total, per protocol instruction. Participants taking additional IS medications (such as tumor necrosis factor [TNF] inhibitors, JAK inhibitors, abatacept, belimumab, etc.) will be required to continue them during the time of the additional vaccine dose.

Arm/Groups

ID	Title	Description	Deaths (At Risk)	Serious Events (Affected)	Serious Events (At Risk)	Other Events (Affected)	Other Events (At Risk)
EG000	Cohort A, Arm A1: Moderna mRNA-1273 + Continue IS (MMF or MPA)	Stage 1 adult participants who are taking mycophenolate mofetil (MMF) or mycophenolic acid (MPA) (without additional B cell depleting medications or methotrexate) for management of their underlying autoimmune disease will receive an additional dose of the Moderna mRNA-1273 COVID-19 vaccine and continue to take their immunosuppressive medications (IS) without alterations in schedule and dosing.	2	0	2	1	2
EG001	Cohort A, Arm A4: Moderna mRNA-1273 + Withhold IS (MMF or MPA)	Stage 1 adult participants who are taking mycophenolate mofetil (MMF) or mycophenolic acid (MPA) (without additional B cell depleting medications or methotrexate) for management of their underlying autoimmune disease will withhold their cohort-defining immunosuppressive medications (IS) 3 days before and 10 days after receiving an additional dose of the Moderna mRNA-1273 COVID-19 vaccine, per protocol instruction. Participants taking additional IS medications (such as tumor necrosis factor [TNF] inhibitors, JAK inhibitors, abatacept, belimumab, etc.) will be required to continue them during the time of the additional vaccine dose.	1	0	1	0	1
EG002	Cohort A, Arm A2: Pfizer-BioNTech + Continue IS (MMF or MPA)	Stage 1 adult participants who are taking mycophenolate mofetil (MMF) or mycophenolic acid (MPA) (without additional B cell depleting medications or methotrexate) for management of their underlying autoimmune disease will receive an additional dose of the Pfizer-BioNTech (BNT162b2) COVID-19 vaccine and continue to take their immunosuppressive medications (IS) without alterations in schedule and dosing.	8	0	8	3	8
EG003	Cohort A, Arm A5: Pfizer-BioNTech + Withhold IS (MMF or MPA)	Stage 1 adult participants who are taking mycophenolate mofetil (MMF) or mycophenolic acid (MPA) (without additional B cell depleting medications or methotrexate) for management of their underlying autoimmune disease will withhold their cohort-defining immunosuppressive medications (IS) 3 days before and 10 days after receiving an additional dose of the Pfizer-BioNTech (BNT162b2) COVID-19 vaccine, per protocol instruction. Participants taking additional IS medications (such as tumor necrosis factor [TNF] inhibitors, JAK inhibitors, abatacept, belimumab, etc.) will be required to continue them during the time of the additional vaccine dose.	9	0	9	4	9
EG004	Cohort A, Arm A6: Janssen + Withhold IS (MMF or MPA)	Stage 1 adult participants who are taking mycophenolate mofetil (MMF) or mycophenolic acid (MPA) (without additional B cell depleting medications or methotrexate) for management of their underlying autoimmune disease will withhold their cohort-defining immunosuppressive medications (IS) 3 days before and 10 days after receiving an additional dose of the Ad26.COV2.S (Janssen) COVID-19 vaccine, per protocol instruction. Participants taking additional IS medications (such as tumor necrosis factor [TNF] inhibitors, JAK inhibitors, abatacept, belimumab, etc.) will be required to continue them during the time of the additional vaccine dose.	2	1	2	0	2
EG005	Cohort B, Arm B1: Moderna mRNA-1273 + Continue IS (MTX)	Stage 1 adult participants who are taking methotrexate (MTX) (without additional B cell depleting medications or mycophenolate mofetil or mycophenolic acid) for management of their underlying autoimmune disease will receive an additional dose of the Moderna mRNA-1273 COVID-19 vaccine and continue to take their immunosuppressive medications (IS) without alterations in schedule and dosing.	3	0	3	2	3
EG006	Cohort B, Arm B4: Moderna mRNA-1273 + Withhold IS (MTX)	Stage 1 adult participants who are taking methotrexate (MTX) (without additional B cell depleting medications or mycophenolate mofetil or mycophenolic acid) for management of their underlying autoimmune disease will withhold their cohort-defining immunosuppressive medications (IS) for at least 7 days before and at least 7 days after receiving an additional dose of the Moderna mRNA-1273 COVID-19 vaccine (but not for more than 21 days total), per protocol instruction. Participants taking additional IS medications (such as tumor necrosis factor [TNF] inhibitors, JAK inhibitors, abatacept, belimumab, etc.) will be required to continue them during the time of the additional vaccine dose.	3	0	3	0	3
EG007	Cohort B, Arm B2: Pfizer-BioNTech + Continue IS (MTX)	Stage 1 adult participants who are taking methotrexate (MTX) (without additional B cell depleting medications or mycophenolate mofetil or mycophenolic acid) for management of their underlying autoimmune disease will receive an additional dose of the Pfizer-BioNTech (BNT162b2) COVID-19 vaccine and continue to take their immunosuppressive medications (IS) without alterations in schedule and dosing.	10	0	10	3	10
EG008	Cohort B, Arm B5: Pfizer-BioNTech + Withhold IS (MTX)	Stage 1 adult participants who are taking methotrexate (MTX) (without additional B cell depleting medications or mycophenolate mofetil or mycophenolic acid) for management of their underlying autoimmune disease will withhold their cohort-defining immunosuppressive medications (IS) for at least 7 days before and at least 7 days after receiving an additional dose of the Pfizer-BioNTech (BNT162b2) COVID-19 vaccine (but not for more than 21 days total), per protocol instruction. Participants taking additional IS medications (such as tumor necrosis factor [TNF] inhibitors, JAK inhibitors, abatacept, belimumab, etc.) will be required to continue them during the time of the additional vaccine dose.	10	1	10	5	10
EG009	Cohort C, Arm C1: Moderna mRNA-1273 + Continue IS (BCDT)	Stage 1 adult participants taking B cell depletion therapy (BCDT) for management of their underlying autoimmune disease, regardless of whether they are also taking methotrexate, mycophenolate mofetil or mycophenolic acid, will receive an additional dose of the Moderna mRNA-1273 COVID-19 vaccine and continue to take their immunosuppressive medications (IS) without alterations in schedule and dosing.	40	5	40	15	40
EG010	Cohort C, Arm C2: Pfizer-BioNTech + Continue IS (BCDT)	Stage 1 adult participants taking B cell depletion therapy (BCDT) for management of their underlying autoimmune disease, regardless of whether they are also taking methotrexate, mycophenolate mofetil or mycophenolic acid, will receive an additional dose of the Pfizer-BioNTech (BNT162b2) COVID-19 vaccine and continue to take their immunosuppressive medications (IS) without alterations in schedule and dosing.	45	4	45	12	45
EG011	Cohort C, Arm C3: Janssen + Continue IS (BCDT)	Stage 1 adult participants taking B cell depletion therapy (BCDT) for management of their underlying autoimmune disease, regardless of whether they are also taking methotrexate, mycophenolate mofetil or mycophenolic acid, will receive an additional dose of the Ad26.COV2.S (Janssen) COVID-19 vaccine and continue to take their immunosuppressive medications (IS) without alterations in schedule and dosing.	8	0	8	6	8
EG012	Cohort D, Arm D2: Alternative mRNA + Withhold IS (MMF or MPA)	Stage 2 adult participants who previously received an mRNA vaccine and who are taking mycophenolate mofetil (MMF) or mycophenolic acid (MPA) (without additional B cell depleting medications or methotrexate) for management of their underlying autoimmune disease, will withhold their cohort-defining immunosuppressive medications (IS) 3 days before and 10 days after receiving a dose of an alternative COVID-19 vaccine (Moderna mRNA-1273 or Pfizer-BioNTech (BNT162b2), per protocol instruction. Participants taking additional IS medications (such as tumor necrosis factor [TNF] inhibitors, JAK inhibitors, abatacept, belimumab, etc.) will be required to continue them during the time of the additional vaccine dose.	9	1	9	5	9
EG013	Cohort D, Arm D4: Sanofi-GSK + Withhold IS (MMF or MPA)	Stage 2 adult participants who previously received an mRNA vaccine and who are taking mycophenolate mofetil (MMF) or mycophenolic acid (MPA) (without additional B cell depleting medications or methotrexate) for management of their underlying autoimmune disease, will withhold their cohort-defining immunosuppressive medications (IS) 3 days before and 10 days after receiving a dose of the Sanofi-GSK (Monovalent [B.1.351] CoV2 preS dTM-AS03) COVID-19 vaccine, per protocol instruction. Participants taking additional IS medications (such as tumor necrosis factor [TNF] inhibitors, JAK inhibitors, abatacept, belimumab, etc.) will be required to continue them during the time of the additional vaccine dose.	5	1	5	2	5
EG014	Cohort E, Arm E2: Alternative mRNA + Withhold IS (MTX)	Stage 2 adult participants who previously received an mRNA vaccine and who are taking methotrexate (MTX) (without additional B cell depleting medications or mycophenolate mofetil or mycophenolic acid) for management of their underlying autoimmune disease will withhold their cohort-defining immunosuppressive medications (IS) for at least 7 days before and at least 7 days after receiving a dose of an alternative COVID-19 vaccine (Moderna mRNA-1273 or Pfizer-BioNTech (BNT162b2), but not for more than 21 days total, per protocol instruction. Participants taking additional IS medications (such as tumor necrosis factor [TNF] inhibitors, JAK inhibitors, abatacept, belimumab, etc.) will be required to continue them during the time of the additional vaccine dose.	8	0	8	3	8
EG015	Cohort E, Arm E4: Sanofi-GSK + Withhold IS (MTX)	Stage 2 adult participants who previously received an mRNA vaccine and who are taking methotrexate (MTX) (without additional B cell depleting medications or mycophenolate mofetil or mycophenolic acid) for management of their underlying autoimmune disease will withhold their cohort-defining immunosuppressive medications (IS) for at least 7 days before and at least 7 days after receiving a dose of the Sanofi-GSK (Monovalent [B.1.351] CoV2 preS dTM-AS03) vaccine, but not for more than 21 days total, per protocol instruction. Participants taking additional IS medications (such as tumor necrosis factor [TNF] inhibitors, JAK inhibitors, abatacept, belimumab, etc.) will be required to continue them during the time of the additional vaccine dose.	6	0	6	4	6
EG016	Cohort F, Arm F2: Alternative mRNA + Withhold IS (BCDT)	Stage 2 adult participants who previously received an mRNA COVID-19 vaccine and who are taking B cell depletion therapy (BCDT) for management of their underlying autoimmune disease, regardless of whether they are also taking methotrexate (MTX), mycophenolate mofetil (MMF) or mycophenolic acid (MPA), will continue to take their prescribed, cohort-defining, immunosuppressive medications (IS) without alterations in schedule and dosing. Participants who are taking MMF, MPA, or MTX in addition to BCDTs will withhold these medications (MMF, MPA, or MTX) before and after receiving a dose of the alternative COVID-19 vaccine (Moderna mRNA-1273 or Pfizer-BioNTech (BNT162b2), per protocol instruction. MMF and MPA: hold 3 days before and 10 days after vaccine. MTX: hold for at least 7 days before and at least 7 days after vaccine, but not for more than 21 days total.	53	6	53	20	53
EG017	Cohort F, Arm F3: Moderna mRNA-1273 + Withhold IS (BCDT)	Stage 2 adult participants who previously received the Janssen COVID-19 vaccine and who are taking B cell depletion therapy (BCDT) for management of their underlying autoimmune disease, regardless of whether they are also taking methotrexate (MTX), mycophenolate mofetil (MMF) or mycophenolic acid (MPA), will continue to take their prescribed, cohort-defining, immunosuppressive medications (IS) without alterations in schedule and dosing. Participants who are taking MMF, MPA, or MTX in addition to BCDTs will withhold these medications (MMF, MPA, or MTX) before and after receiving a dose of the Moderna mRNA-1273 vaccine, per protocol instruction. MMF and MPA: hold 3 days before and 10 days after vaccine. MTX: hold for at least 7 days before and at least 7 days after vaccine, but not for more than 21 days total.	2	0	2	0	2
EG018	Cohort F, Arm F4: Sanofi-GSK + Withhold IS (BCDT)	Stage 2 adult participants who previously received an mRNA COVID-19 vaccine and who are taking B cell depletion therapy (BCDT) for management of their underlying autoimmune disease, regardless of whether they are also taking methotrexate (MTX), mycophenolate mofetil (MMF) or mycophenolic acid (MPA), will continue to take their prescribed, cohort-defining, immunosuppressive medications (IS) without alterations in schedule and dosing. Participants who are taking MMF, MPA, or MTX in addition to BCDTs will withhold these medications (MMF, MPA, or MTX) before and after receiving a dose of the Sanofi-GSK (Monovalent [B.1.351] CoV2 preS dTM-AS03) vaccine, per protocol instruction. MMF and MPA: hold 3 days before and 10 days after vaccine. MTX: hold for at least 7 days before and at least 7 days after vaccine, but not for more than 21 days total.	20	1	20	9	20
EG019	Cohort D, Arm D2P: Moderna mRNA-1273 + Withhold IS (MMF/MPA)	Stage 2 pediatric participants who previously received the Pfizer-BioNTech COVID-19 vaccine and who are taking mycophenolate mofetil (MMF) or mycophenolic acid (MPA) (without additional B cell depleting medications or methotrexate) for management of their underlying autoimmune disease, will withhold their cohort-defining immunosuppressive medications (IS) 3 days before and 10 days after receiving a dose of the Moderna mRNA-1273 Bivalent COVID-19 vaccine, per protocol instruction. Participants taking additional IS medications (such as tumor necrosis factor [TNF] inhibitors, JAK inhibitors, abatacept, belimumab, etc.) will be required to continue them during the time of the additional vaccine dose.	1	0	1	0	1
EG020	Cohort E, Arm E2P: Moderna mRNA-1273 + Withhold IS (MTX)	Stage 2 pediatric participants who previously received the Pfizer-BioNTech COVID-19vaccine and who are taking methotrexate (MTX) (without additional B cell depleting medications or mycophenolate mofetil or mycophenolic acid) for management of their underlying autoimmune disease will withhold their cohort-defining immunosuppressive medications (IS) for at least 7 days before and at least 7 days after receiving a dose of the Moderna mRNA-1273 Bivalent vaccine, but not for more than 21 days total, per protocol instruction. Participants taking additional IS medications (such as tumor necrosis factor [TNF] inhibitors, JAK inhibitors, abatacept, belimumab, etc.) will be required to continue them during the time of the additional vaccine dose.	1	0	1	0	1

Serious Adverse Events

Term	Organ System	Source Vocabulary	Assessment Type	Statistical Information
Febrile neutropenia	Blood and lymphatic system disorders	24.0	Systematic Assessment	EG0000 events0 affected2 at risk EG0010 events0 affected1 at risk EG0020 events0 affected8 at risk EG0030 events0 affected9 at risk EG0040 events0 affected2 at risk EG0050 events0 affected3 at risk EG0060 events0 affected3 at risk EG0070 events0 affected10 at risk EG0080 events0 affected10 at risk EG0090 events0 affected40 at risk EG0101 events1 affected45 at risk EG0110 events0 affected8 at risk EG0120 events0 affected9 at risk EG0130 events0 affected5 at risk EG0140 events0 affected8 at risk EG0150 events0 affected6 at risk EG0160 events0 affected53 at risk EG0170 events0 affected2 at risk EG0180 events0 affected20 at risk EG0190 events0 affected1 at risk EG0200 events0 affected1 at risk
Iron deficiency anaemia	Blood and lymphatic system disorders	24.0	Systematic Assessment	EG0000 events0 affected2 at risk EG0010 events0 affected1 at risk EG0020 events0 affected8 at risk EG003
Acute myocardial infarction	Cardiac disorders	24.0	Systematic Assessment	EG0000 events0 affected2 at risk EG0010 events0 affected1 at risk EG0020 events0 affected8 at risk EG003
Atrial fibrillation	Cardiac disorders	24.0	Systematic Assessment	EG0000 events0 affected2 at risk EG0010 events0 affected1 at risk EG0020 events0 affected8 at risk EG003
Cardiac failure acute	Cardiac disorders	24.0	Systematic Assessment	EG0000 events0 affected2 at risk EG0010 events0 affected1 at risk EG0020 events0 affected8 at risk EG003
Cardiomyopathy alcoholic	Cardiac disorders	24.0	Systematic Assessment	EG0000 events0 affected2 at risk EG0010 events0 affected1 at risk EG0020 events0 affected8 at risk EG003
Myocardial infarction	Cardiac disorders	24.0	Systematic Assessment	EG0000 events0 affected2 at risk EG0010 events0 affected1 at risk EG0020 events0 affected8 at risk EG003
Pulmonary malformation	Congenital, familial and genetic disorders	24.0	Systematic Assessment	EG0000 events0 affected2 at risk EG0010 events0 affected1 at risk EG0020 events0 affected8 at risk EG003
COVID-19	Infections and infestations	24.0	Systematic Assessment	EG0000 events0 affected2 at risk EG0010 events0 affected1 at risk EG0020 events0 affected8 at risk EG003
COVID-19 pneumonia	Infections and infestations	24.0	Systematic Assessment	EG0000 events0 affected2 at risk EG0010 events0 affected1 at risk EG0020 events0 affected8 at risk EG003
Cellulitis	Infections and infestations	24.0	Systematic Assessment	EG0000 events0 affected2 at risk EG0010 events0 affected1 at risk EG0020 events0 affected8 at risk EG003
Diverticulitis	Infections and infestations	24.0	Systematic Assessment	EG0000 events0 affected2 at risk EG0010 events0 affected1 at risk EG0020 events0 affected8 at risk EG003
Herpes zoster	Infections and infestations	24.0	Systematic Assessment	EG0000 events0 affected2 at risk EG0010 events0 affected1 at risk EG0020 events0 affected8 at risk EG003
Meningitis viral	Infections and infestations	24.0	Systematic Assessment	EG0000 events0 affected2 at risk EG0010 events0 affected1 at risk EG0020 events0 affected8 at risk EG003
Pneumonia bacterial	Infections and infestations	24.0	Systematic Assessment	EG0000 events0 affected2 at risk EG0010 events0 affected1 at risk EG0020 events0 affected8 at risk EG003
Urinary tract infection	Infections and infestations	24.0	Systematic Assessment	EG0000 events0 affected2 at risk EG0010 events0 affected1 at risk EG0020 events0 affected8 at risk EG003
Urosepsis	Infections and infestations	24.0	Systematic Assessment	EG0000 events0 affected2 at risk EG0010 events0 affected1 at risk EG0020 events0 affected8 at risk EG003
Viral infection	Infections and infestations	24.0	Systematic Assessment	EG0000 events0 affected2 at risk EG0010 events0 affected1 at risk EG0020 events0 affected8 at risk EG003
Adenocarcinoma	Neoplasms benign, malignant and unspecified (incl cysts and polyps)	24.0	Systematic Assessment	EG0000 events0 affected2 at risk EG0010 events0 affected1 at risk EG0020 events0 affected8 at risk EG003
Transient ischaemic attack	Nervous system disorders	24.0	Systematic Assessment	EG0000 events0 affected2 at risk EG0010 events0 affected1 at risk EG0020 events0 affected8 at risk EG003
Uhthoff's phenomenon	Nervous system disorders	24.0	Systematic Assessment	EG0000 events0 affected2 at risk EG0010 events0 affected1 at risk EG0020 events0 affected8 at risk EG003
Pemphigus	Skin and subcutaneous tissue disorders	24.0	Systematic Assessment	EG0000 events0 affected2 at risk EG0010 events0 affected1 at risk EG0020 events0 affected8 at risk EG003
Haematoma	Vascular disorders	24.0	Systematic Assessment	EG0000 events0 affected2 at risk EG0010 events0 affected1 at risk EG0020 events0 affected8 at risk EG003

Other Adverse Events

Term	Organ System	Source Vocabulary	Assessment Type	Statistical Information
Tachycardia	Cardiac disorders	24.0	Systematic Assessment	EG0000 events0 affected2 at risk EG0010 events0 affected1 at risk EG0021 events1 affected8 at risk EG0030 events0 affected9 at risk EG0040 events0 affected2 at risk EG0050 events0 affected3 at risk EG0060 events0 affected3 at risk EG0070 events0 affected10 at risk EG0080 events0 affected10 at risk EG0090 events0 affected40 at risk EG0100 events0 affected45 at risk EG0110 events0 affected8 at risk EG0121 events1 affected9 at risk EG0130 events0 affected5 at risk EG0140 events0 affected8 at risk EG0150 events0 affected6 at risk EG0160 events0 affected53 at risk EG0170 events0 affected2 at risk EG0180 events0 affected20 at risk EG0190 events0 affected1 at risk EG0200 events0 affected1 at risk
Chest pain	General disorders	24.0	Systematic Assessment	EG0000 events0 affected2 at risk EG0010 events0 affected1 at risk EG0020 events0 affected8 at risk EG003
Injection site induration	General disorders	24.0	Systematic Assessment	EG0000 events0 affected2 at risk EG0010 events0 affected1 at risk EG0020 events0 affected8 at risk EG003
Injection site pain	General disorders	24.0	Systematic Assessment	EG0000 events0 affected2 at risk EG0010 events0 affected1 at risk EG0020 events0 affected8 at risk EG003
Injection site reaction	General disorders	24.0	Systematic Assessment	EG0000 events0 affected2 at risk EG0010 events0 affected1 at risk EG0020 events0 affected8 at risk EG003
Injection site swelling	General disorders	24.0	Systematic Assessment	EG0000 events0 affected2 at risk EG0010 events0 affected1 at risk EG0020 events0 affected8 at risk EG003
COVID-19	Infections and infestations	24.0	Systematic Assessment	EG0001 events1 affected2 at risk EG0010 events0 affected1 at risk EG0023 events3 affected8 at risk EG003
Herpes zoster	Infections and infestations	24.0	Systematic Assessment	EG0000 events0 affected2 at risk EG0010 events0 affected1 at risk EG0021 events1 affected8 at risk EG003
Oral herpes	Infections and infestations	24.0	Systematic Assessment	EG0000 events0 affected2 at risk EG0010 events0 affected1 at risk EG0020 events0 affected8 at risk EG003
Pneumonia	Infections and infestations	24.0	Systematic Assessment	EG0000 events0 affected2 at risk EG0010 events0 affected1 at risk EG0020 events0 affected8 at risk EG003
Urinary tract infection	Infections and infestations	24.0	Systematic Assessment	EG0000 events0 affected2 at risk EG0010 events0 affected1 at risk EG0020 events0 affected8 at risk EG003
Viral upper respiratory tract infection	Infections and infestations	24.0	Systematic Assessment	EG0000 events0 affected2 at risk EG0010 events0 affected1 at risk EG0020 events0 affected8 at risk EG003
Fall	Injury, poisoning and procedural complications	24.0	Systematic Assessment	EG0000 events0 affected2 at risk EG0010 events0 affected1 at risk EG0020 events0 affected8 at risk EG003
Gout	Metabolism and nutrition disorders	24.0	Systematic Assessment	EG0000 events0 affected2 at risk EG0010 events0 affected1 at risk EG0020 events0 affected8 at risk EG003
Hyperglycaemia	Metabolism and nutrition disorders	24.0	Systematic Assessment	EG0000 events0 affected2 at risk EG0010 events0 affected1 at risk EG0020 events0 affected8 at risk EG003
Neck mass	Musculoskeletal and connective tissue disorders	24.0	Systematic Assessment	EG0000 events0 affected2 at risk EG0010 events0 affected1 at risk EG0020 events0 affected8 at risk EG003
Post herpetic neuralgia	Nervous system disorders	24.0	Systematic Assessment	EG0000 events0 affected2 at risk EG0010 events0 affected1 at risk EG0020 events0 affected8 at risk EG003
Skin ulcer	Skin and subcutaneous tissue disorders	24.0	Systematic Assessment	EG0000 events0 affected2 at risk EG0010 events0 affected1 at risk EG0020 events0 affected8 at risk EG003
Hypertension	Vascular disorders	24.0	Systematic Assessment	EG0000 events0 affected2 at risk EG0010 events0 affected1 at risk EG0020 events0 affected8 at risk EG003

ID	Term
D001172	Arthritis, Rheumatoid
D008180	Lupus Erythematosus, Systemic
D010392	Pemphigus
D009103	Multiple Sclerosis
D012595	Scleroderma, Systemic
D001171	Arthritis, Juvenile
D003882	Dermatomyositis
D000086382	COVID-19
D001327	Autoimmune Diseases

ID	Term
D001168	Arthritis
D007592	Joint Diseases
D009140	Musculoskeletal Diseases
D012216	Rheumatic Diseases
D003240	Connective Tissue Diseases
D017437	Skin and Connective Tissue Diseases
D007154	Immune System Diseases
D012872	Skin Diseases, Vesiculobullous
D012871	Skin Diseases
D020278	Demyelinating Autoimmune Diseases, CNS
D020274	Autoimmune Diseases of the Nervous System
D009422	Nervous System Diseases
D003711	Demyelinating Diseases
D017285	Polymyositis
D009220	Myositis
D009135	Muscular Diseases
D009468	Neuromuscular Diseases
D011024	Pneumonia, Viral
D011014	Pneumonia
D012141	Respiratory Tract Infections
D007239	Infections
D014777	Virus Diseases
D018352	Coronavirus Infections
D003333	Coronaviridae Infections
D030341	Nidovirales Infections
D012327	RNA Virus Infections
D008171	Lung Diseases
D012140	Respiratory Tract Diseases

ID	Term
D000090983	2019-nCoV Vaccine mRNA-1273
D000086663	COVID-19 Vaccines
D000090982	BNT162 Vaccine
D000090984	Ad26COVS1
D009173	Mycophenolic Acid
D008727	Methotrexate
D000096106	BNT162b5

ID	Term
D000087503	mRNA Vaccines
D000087504	Nucleic Acid-Based Vaccines
D014614	Vaccines, Synthetic
D011994	Recombinant Proteins
D011506	Proteins
D000602	Amino Acids, Peptides, and Proteins
D014612	Vaccines
D001688	Biological Products
D045424	Complex Mixtures
D014765	Viral Vaccines
D000941	Antigens
D001685	Biological Factors
D002208	Caproates
D000144	Acids, Acyclic
D002264	Carboxylic Acids
D009930	Organic Chemicals
D005227	Fatty Acids
D008055	Lipids
D000630	Aminopterin
D011622	Pterins
D011621	Pteridines
D006574	Heterocyclic Compounds, 2-Ring
D000072471	Heterocyclic Compounds, Fused-Ring
D006571	Heterocyclic Compounds
D017778	Vaccines, Combined