Systemic lupus erythematosus in the light of the COVID-19 pandemic: infection, vaccination, and impact on disease management

Abstract

Patients with systemic lupus erythematosus (SLE) form a vulnerable group in terms of the impact of the COVID-19 pandemic on disease management. We conducted this overview by searches through Medline/PubMed, Scopus, and the Directory of Open Access Journals (DOAJ). The prevalence and severity of COVID-19, efficacy of COVID-19 vaccination, impact on the management of SLE, and the attitudes of SLE patients to COVID-19 and vaccination were explored. After screening and due exclusions, 198 studies were included for the final review. Patients with SLE have a greater risk of acquiring COVID-19 (0.6–22%) and related hospitalization (30%), severe disease (13.5%), and death (6.5%) than the general population. Older age, male gender, comorbidities, moderate or high disease activity, and glucocorticoid, rituximab, and cyclophosphamide use are associated with unfavorable outcomes, whereas methotrexate and belimumab use showed no association with outcomes. COVID-19 vaccines are safe in SLE with minimal risk of severe flares (< 2%). Vaccine efficacy is negatively associated with glucocorticoids. The overall attitude of patients towards vaccination is positive (54–90%). The pandemic has negatively affected access to medical care, hospitalizations, procurement of drugs, employment, and the mental health of patients which need to be addressed as part of holistic care in SLE. Key Points • Lupus patients are at a greater risk of acquiring COVID-19, related hospitalization, severe disease, and death than the general population. • COVID-19 vaccines are relatively safe for lupus patients with minimal risk of severe flares. • Lupus patients’ attitude towards COVID-19 vaccination is predominantly positive.

Pediatric Systemic Lupus Erythematous in COVID-19 Era

“…The presence of comorbidities, organ related damages, intrinsic immune failure and immunosuppressive treatment amplify the concern of medical practitioners related to these patients [ 14 , 15 ]. The immune dysregulation of the interferon pathway encountered in SLE is another reason of concern, mainly because of its role in the innate immune response during the new coronavirus infection [ 14 , 15 , 16 ].…”

Factors associated with poor outcomes in SLE patients with COVID-19: Data from ReumaCoV-Brazil register

“…Current evidence suggests that disease activity itself is a factor associated with a worse outcome in COVID-19 and the discontinuation of immunosuppressive medications is not recommended, although glucocorticoids should always be used in the lowest possible dose. 43 The Global Rheumatology Alliance analyses also demonstrated that individuals not receiving treatment for their SLE at the time of COVID-19 diagnosis had poorer outcomes, probably multifactorial, lack of access to SLE care or treatment, or poor adherence with medications. 32 Telemedicine, a strategy that enables the prevision of medical services remotely and that ensures social distancing, increased exponentially during the pandemic.…”

Belimumab or anifrolumab for systemic lupus erythematosus? A risk-benefit assessment

“…Together, even long-term inhibition of BAFF does not seem to be associated with significant increases in the rates of infections, although exposures to plasmodium falciparum or other important (sub-)tropical parasites may have been rare in these studies. Interestingly, COVID-19 outcomes have been more favorable in the small subset of patients with SLE treated with belimumab ( 45 , 46 ).…”

“…More patients treated with belimumab developed serious depression, treatment-emergent suicidality, sponsoradjudicated serious suicide, or self-injury events (44). On the other hand, severe COVID-19 outcomes in individuals with SLE were favorable with belimumab (45,46). Unlike anti-BAFF, anti-IFNAR1 significantly increased the rates of certain viral infections such as HZ and perhaps influenza, a finding that connects well with its mechanism-of-action that blocks a key element of antiviral immunity.…”