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Lupus, vaccinations and COVID-19: what we know now

Lupus, vaccinations and COVID-19: what we know now
Lupus, vaccinations and COVID-19: what we know now

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), the virus causing Coronavirus disease 2019 (COVID-19), has had a huge impact on health services, with a high mortality associated with complications including pneumonia and acute respiratory distress syndrome. Patients with systemic lupus erythematosus (SLE) are at increased risk of viral infections, and recent data suggests they may be at an increased risk of poor outcomes with COVID-19. This may be particularly true for those on rituximab or high dose steroids. A huge international effort from the scientific community has so far resulted in the temporary authorisation of three vaccines which offer protection against SARS-CoV-2, with over 30 other vaccines being evaluated in ongoing trials. Although there has historically been concern that vaccines may trigger disease flares of SLE, there is little convincing evidence to show this. In general lupus patients appear to gain good protection from vaccination, although there may be reduced efficacy in those with high disease activity or those on immunosuppressive therapies, such as rituximab or high dose steroids. Recent concerns have been raised regarding rare clotting events with the AstraZeneca/Oxford vaccine and it is currently unknown whether this risk is higher for those patients with secondary antiphospholipid syndrome. With the possibility of annual COVID vaccination programmes in the future, prospective data collection and registries looking at the effect of vaccination on SLE disease control, the incidence of COVID-19 in SLE patients and severity of COVID-19 disease course would all be useful. As mass vaccination programmes begin to roll out across the world, we assess the evidence of the use of vaccines in SLE patients and in particular vaccines targeting SARS-CoV-2.

COVID-19, Systemic lupus erythematosus, vaccines
0961-2033
1541-1552
Mason, Alice
3a78776d-13b0-48b5-ba8a-e7ef5b2a057b
Anver, Himashi
089e265b-b0f4-4c93-937c-b5d24afac18d
Lwin, May
c9c177cc-2633-4aee-b282-9f767b2b0760
Holroyd, Christopher
38511e1e-7504-45d0-ab00-eacf22108b7a
Faust, Saul N.
f97df780-9f9b-418e-b349-7adf63e150c1
Edwards, Christopher J.
dcb27fec-75ea-4575-a844-3588bcf14106
Mason, Alice
3a78776d-13b0-48b5-ba8a-e7ef5b2a057b
Anver, Himashi
089e265b-b0f4-4c93-937c-b5d24afac18d
Lwin, May
c9c177cc-2633-4aee-b282-9f767b2b0760
Holroyd, Christopher
38511e1e-7504-45d0-ab00-eacf22108b7a
Faust, Saul N.
f97df780-9f9b-418e-b349-7adf63e150c1
Edwards, Christopher J.
dcb27fec-75ea-4575-a844-3588bcf14106

Mason, Alice, Anver, Himashi, Lwin, May, Holroyd, Christopher, Faust, Saul N. and Edwards, Christopher J. (2021) Lupus, vaccinations and COVID-19: what we know now. Lupus, 30 (10), 1541-1552. (doi:10.1177/09612033211024355).

Record type: Review

Abstract

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), the virus causing Coronavirus disease 2019 (COVID-19), has had a huge impact on health services, with a high mortality associated with complications including pneumonia and acute respiratory distress syndrome. Patients with systemic lupus erythematosus (SLE) are at increased risk of viral infections, and recent data suggests they may be at an increased risk of poor outcomes with COVID-19. This may be particularly true for those on rituximab or high dose steroids. A huge international effort from the scientific community has so far resulted in the temporary authorisation of three vaccines which offer protection against SARS-CoV-2, with over 30 other vaccines being evaluated in ongoing trials. Although there has historically been concern that vaccines may trigger disease flares of SLE, there is little convincing evidence to show this. In general lupus patients appear to gain good protection from vaccination, although there may be reduced efficacy in those with high disease activity or those on immunosuppressive therapies, such as rituximab or high dose steroids. Recent concerns have been raised regarding rare clotting events with the AstraZeneca/Oxford vaccine and it is currently unknown whether this risk is higher for those patients with secondary antiphospholipid syndrome. With the possibility of annual COVID vaccination programmes in the future, prospective data collection and registries looking at the effect of vaccination on SLE disease control, the incidence of COVID-19 in SLE patients and severity of COVID-19 disease course would all be useful. As mass vaccination programmes begin to roll out across the world, we assess the evidence of the use of vaccines in SLE patients and in particular vaccines targeting SARS-CoV-2.

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SLE Vaccine Article_V5 CH_CE - Accepted Manuscript
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SLE Vaccine Article_V5 CH_CE
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More information

Accepted/In Press date: 20 May 2021
e-pub ahead of print date: 17 June 2021
Published date: September 2021
Additional Information: Publisher Copyright: © The Author(s) 2021. Copyright: Copyright 2021 Elsevier B.V., All rights reserved.
Keywords: COVID-19, Systemic lupus erythematosus, vaccines

Identifiers

Local EPrints ID: 450632
URI: http://eprints.soton.ac.uk/id/eprint/450632
ISSN: 0961-2033
PURE UUID: 6b23ebc1-9555-465b-bd14-84ee5a2804cb
ORCID for Saul N. Faust: ORCID iD orcid.org/0000-0003-3410-7642

Catalogue record

Date deposited: 05 Aug 2021 16:31
Last modified: 26 Nov 2021 02:50

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Contributors

Author: Alice Mason
Author: Himashi Anver
Author: May Lwin
Author: Christopher Holroyd
Author: Saul N. Faust ORCID iD

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