COVID-19 vaccination in systemic lupus erythematosus: a systematic review of its effectiveness, immunogenicity, flares and acceptance

Objectives COVID-19 infection is associated with significant morbidity in systemic lupus erythematosus but is potentially preventable by vaccination, although the impact of the myriad vaccines among SLE patients is not established. We aimed to assess the effectiveness, efficacy, acceptance and safety of COVID-19 vaccination in SLE.Methods We performed a systematic review of PubMed, EMBASE, CENTRAL, and Scopus publications until 8 June 2022 without language, publication year or publication status restrictions. Reports with fewer than 5 patients or incomplete information on study outcomes were excluded. Risk of bias was assessed, and results reported according to the PRISMA 2020 guidelines.Results We identified 32 studies (34 reports) comprising 8269 individuals with SLE. Post-vaccine COVID-19 infections ranged from 0 to 17% in 6 studies (5065 patients), while humoral and cellular immunogenicity was evaluated in 17 studies (976 patients) and 5 studies (112 patients), respectively. The pooled seropositivity rate was 81.1% (95% CI: 72.6, 88.5%, I-2 = 85%, P < 0.01), with significant heterogeneity and higher rates for mRNA vaccines compared with non-mRNA vaccines. Adverse events and specifically lupus flares were examined in 20 studies (3853 patients) and 13 studies (2989 patients), respectively. Severe adverse events and moderate to severe lupus flares were infrequent. The pooled vaccine acceptance rate was 67.0% (95% CI: 45.2, 85.6%, I-2=98%, P < 0.01) from 8 studies (1348 patients), with greater acceptance in older patients.Conclusion Among SLE patients, post-vaccine COVID-19 infections, severe flares, and adverse events were infrequent, while pooled seropositivity and acceptance were high, with significant heterogeneity. These results may inform shared decision-making on vaccination during the ongoing COVID-19 pandemic.