Division of Rheumatology, Department of Medicine, Columbia University Irving Medical Center, 630 West 168th Street, P&S 10-508, New York, NY, 10032, USA.
Columbia University Vagelos College of Physicians and Surgeons, New York, NY, 10032, USA.
Curr Rheumatol Rep. 2021 Nov 12;23(11):79. doi: 10.1007/s11926-021-01046-2.
Three COVID-19 vaccines obtained emergency authorization from the Food and Drug Administration (FDA) and are widely used in the USA. Unfortunately, there is a paucity of evidence on the safety and efficacy of these vaccines in patients with autoimmune inflammatory rheumatic diseases (AIIRD), as these patients were excluded from all phases of vaccine development. Here we reviewed current data on COVID-19 vaccination in patients with AIIRD, with emphasis on systemic lupus erythematosus (SLE), and provided a comprehensive update on the benefits and risks of vaccination.
Patients with SLE have worse immune responses following SARS-CoV-2 vaccination than healthy controls. The efficacy of the COVID-19 vaccines seems to be further reduced by immunosuppressive medications, such as glucocorticoids (GC), methotrexate (MTX), mycophenolate/mycophenolic acid (MMF), and rituximab (RTX). However, these data do not substantiate that AIIRD patients are at greater risk of disease flares or have a higher incidence of side effects following vaccination. There is no significant safety concern for the use of COVID-19 vaccines in patients with AIIRD. The benefits of vaccination far outweigh the risks in patients with AIIRD, including SLE. More data are needed to determine the necessity of a booster vaccine dose and appropriate adjustment of immunosuppressants around the administration of vaccine.
三种 COVID-19 疫苗获得了美国食品和药物管理局（FDA）的紧急授权，并在美国广泛使用。不幸的是，由于这些患者被排除在疫苗开发的所有阶段之外，因此关于这些疫苗在自身免疫性炎症性风湿病（AIIRD）患者中的安全性和有效性的数据很少。在这里，我们回顾了 AIIRD 患者 COVID-19 疫苗接种的现有数据，重点是系统性红斑狼疮（SLE），并全面更新了疫苗接种的益处和风险。
与健康对照组相比，SLE 患者在接种 SARS-CoV-2 疫苗后免疫反应更差。免疫抑制药物（如糖皮质激素（GC）、甲氨蝶呤（MTX）、霉酚酸/霉酚酸酯（MMF）和利妥昔单抗（RTX））似乎进一步降低了 COVID-19 疫苗的疗效。然而，这些数据并不能证明 AIIRD 患者在接种疫苗后发生疾病发作的风险更高或副作用发生率更高。COVID-19 疫苗在 AIIRD 患者中的使用没有明显的安全性问题。在 AIIRD 患者（包括 SLE 患者）中，疫苗接种的益处远远大于风险。需要更多的数据来确定 AIIRD 患者是否需要加强疫苗剂量以及在接种疫苗时适当调整免疫抑制剂。
