Abstract and Introduction
Abstract
Background: Patients with rheumatic disease (RD) are at increased risk for COVID-19 infection. Large clinical trials have demonstrated efficacy and safety of SARS-CoV-2 vaccine. However, patients with RD are typically excluded from these trials.
Objective: The aim of this study was to conduct a systematic review and meta-analysis examining the immunogenicity and safety of SARS-CoV-2 vaccination in patients with RD.
Methods: We systematically searched PubMed/MEDLINE and Scopus to identify observational studies that examined the immunogenicity and safety of SARS-CoV-2 vaccination in RD patients. Information on disease, immunosuppressant, vaccine type, and proportion of patients with serologic response was obtained from each study.
Results: There were 25 eligible studies. The pooled rate of seroconversion was 0.79 (95% confidence interval [CI], 0.72–0.86). Compared with control subjects, the odds of seroconversion were significantly lower (odds ratio, 0.11; 95% CI, 0.05–0.24). Users of rituximab showed the lowest rate of seroconversion (0.39; 95% CI, 0.29–0.51) followed by mycophenolate (0.56; 95% CI, 0.40–71). On the other hand, users of interleukin 17 (0.94; 95% CI, 0.78–0.98) and tumor necrosis factor inhibitors (0.94; 95% CI, 0.84–0.98) showed high seroconversion rate. Regarding safety of COVID-19 vaccine, approximately 2% of patients reported severe adverse events and 7% reported diseases flares following the first or second dose.
Conclusion: Vaccination against SARS-CoV-2 appears to be safe. Most RD patients developed humoral immune response following vaccination. However, the odds of seroconversion were significantly lower in RD patients compared with controls. This is likely driven by certain immunosuppressants including rituximab and mycophenolate. Future studies need to identify strategies to improve vaccine response in these patients.
Introduction
SARS-CoV-2 pandemic has posited a challenge for many worldwide. Studies have shown that patients with rheumatic disease (RD) are at significantly increased risk for COVID-19 infection.[1] Vaccines represent an essential strategy in lowering the risk of SARS-CoV-2 infection.[2] Organizations such as American College of Rheumatology (ACR) and European Alliance of Associations for Rheumatology (EULAR) recommend prioritizing RD patients for COVID-19 vaccination.[3,4]
Although large clinical trials have proven the safety and efficacy of SARS-CoV-2 vaccine, immunocompromised patients including those with RD are often excluded from such trials.[5–7] Observational studies have examined the immunogenicity and safety of SARS-CoV-2 vaccination in immunocompromised patients.[8–11] Studies including RD patients are limited and typically include smaller sample sizes. There is a need to synthesize findings across studies to better assess serologic response and safety following SARS-CoV-2 vaccination. We thus conducted a systematic review and meta-analysis to study the immunogenicity and safety of SARS-CoV-2 vaccination in patients with RDs.
J Clin Rheumatol. 2022;28(8):381-389. © 2022 Lippincott Williams & Wilkins
