The Use of COVID-19 Vaccines in Patients with SLE

Tang, Wei; Gartshteyn, Yevgeniya; Ricker, Edd; Inzerillo, Sean; Murray, Shane; Khalili, Leila; Askanase, Anca

doi:10.1007/s11926-021-01046-2

Cited by 39 publications

(41 citation statements)

References 46 publications

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“…In our cohort, the most frequent post-injection systemic manifestations were fever, arthralgia and fatigue, both after the first and the second boost. Compared to other studies, all these symptoms were less frequent than previously described (in few studies evaluating SLE patients separately, fatigue and headache were reported by 30–70% of patients) [ 9 , 10 , 16 , 17 , 18 ]. Interestingly, fever was much less frequent (15–20%), but still considerably more than what we observed (4–8% after the first and second boost).…”

Section: Discussioncontrasting

confidence: 69%

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The Impact of Anti-SARS-CoV-2 Vaccine in Patients with Systemic Lupus Erythematosus: A Multicentre Cohort Study

Gerosa

Schioppo²,

Argolini

et al. 2022

Vaccines

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Vulnerable subjects, including systemic lupus erythematosus (SLE) patients, have been prioritised to receive anti-SARS-CoV-2 vaccines. Few data about the safety of these vaccines in SLE are available. The aim of our study is to investigate the safety of anti-SARS-CoV-2 vaccines in SLE. We included 452 SLE patients, referring to seven tertiary centres, who were immunised. A total of 119 (26%) reported side effects (SE) after the first and/or the second shot (the most frequent SE were fever, local reaction, fatigue, and arthralgia). Patients with constitutional symptoms and those on an immunosuppressive regimen (especially belimumab) showed more SE. In addition, 19 (4%) had a flare after the immunisation (flares classified by organ involvement: six musculoskeletal with constitutional symptoms, four renal, three cardio-respiratory, three haematological, two mucocutaneous). None of the patients needed hospitalisation and none died. Moreover, 15 required a transient increase in corticosteroids and four were treated with steroid pulses. One patient required an additional rituximab course. Anti-dsDNA, moderate/high DAS before vaccine, and belimumab were found more frequently in patients with disease flare. Anti-SARS-CoV-2 vaccines are safe in SLE patients, and they should be recommended in these patients, as the potential benefits widely outweigh the risk of SE. Treatment adjustment might be considered with the aim of minimising SE risk and flare.

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Section: Discussioncontrasting

confidence: 69%

“…In a recent review, the benefits of the anti-SARS-CoV-2 vaccine far outweighed the potential risks of side effects or disease flares [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

The Impact of Anti-SARS-CoV-2 Vaccine in Patients with Systemic Lupus Erythematosus: A Multicentre Cohort Study

Gerosa

Schioppo²,

Argolini

et al. 2022

Vaccines

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“…Patients with SLE are at increased risk of thrombosis and/or thrombocytopenia, and the poor outcomes in COVID-19 patients with SLE are known [68] . There is a potential concern that COVID-19 vaccines may worsen SLE and induce coagulopathy, but so far, no significant safety concern for the use of COVID-19 vaccines in patients with SLE and other rheumatic diseases are reported [69] . Nevertheless, the differential diagnosis of SLE from VITT/TTS should be considered.…”

Section: Differential Diagnosismentioning

confidence: 99%

Thrombosis and thrombocytopenia in COVID-19 and after COVID-19 vaccination

Iba

Levy

2022

Trends in Cardiovascular Medicine

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“…In addition, two SLE patients (7%) experienced severe flares shortly after receiving their fourth booster dose. Multiple studies have reported acceptable safety profiles in SLE patients after initial vaccine series [11][12] . However, in an animal model, repeated exposure to the same antigen was shown to induce autoimmunity 13 .…”

Section: Discussionmentioning

confidence: 99%

Immunogenicity of the third and fourth BNT162b2 mRNA COVID-19 boosters and factors associated with immune response in systemic lupus erythematosus and rheumatoid arthritis patients

Assawasaksakul

Sathitratanacheewin

Vichaiwattana

et al. 2022

Preprint

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Objectives: To evaluate the safety and immunogenicity of third and fourth BNT162b2 boosters in systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) patients. Methods: SLE and RA patients aged 18-65 years who completed a series of inactivated, adenoviral vector, or heterogenous adenoviral vector/mRNA vaccines for at least 28 days were enrolled. Immunogenicity assessment was done before and day 15 after each booster vaccination. The third BNT162b2 booster was administered on day 1. Patients with suboptimal humoral response to the third booster dose (anti-receptor binding domain (RBD) IgG on day 15 < 2,360 BAU/mL) were given a fourth BNT162b2 booster on day 22. Results: Seventy one SLE and 29 RA patients were enrolled. The third booster raised anti-RBD IgG by 15 fold and patients with positive neutralizing activity against the Omicron variant increased from 0% to 42%. Patients with positive cellular immune response also increased from 55% to 94%. High immunosuppressive load and initial inactivated vaccine were associated with lower anti-RBD IgG titer. Fifty four patients had suboptimal humoral responses to the third booster and 28 received a fourth booster dose. Although anti-RBD IgG increased further by 7 fold, no significant change in neutralizing activity against the Omicron variant was observed. There were 2 severe SLE flares that occurred shortly after the fourth booster dose. Conclusions: The third BNT162b2 booster significantly improved humoral and cellular immunogenicity in SLE and RA patients. The benefit of a short interval fourth booster in patients with suboptimal humoral response was unclear.

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The Use of COVID-19 Vaccines in Patients with SLE

Cited by 39 publications

References 46 publications

The Impact of Anti-SARS-CoV-2 Vaccine in Patients with Systemic Lupus Erythematosus: A Multicentre Cohort Study

The Impact of Anti-SARS-CoV-2 Vaccine in Patients with Systemic Lupus Erythematosus: A Multicentre Cohort Study

Thrombosis and thrombocytopenia in COVID-19 and after COVID-19 vaccination

Immunogenicity of the third and fourth BNT162b2 mRNA COVID-19 boosters and factors associated with immune response in systemic lupus erythematosus and rheumatoid arthritis patients

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