Dhanasekaran Preeti, Karasu Biraveena Thirunavuc, Mak Anselm
Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
Division of Rheumatology, Department of Medicine, University Medicine Cluster, National University Health System, Singapore, Singapore.
Rheumatol Int. 2024 Dec;44(12):2757-2794. doi: 10.1007/s00296-024-05734-x. Epub 2024 Nov 22.
Patients with autoimmune inflammatory rheumatic diseases (AIIRD) are potentially at a higher risk of contracting the SARS-CoV-2 virus and have poorer outcomes of the infection as a result of their immunocompromised state due to the nature of the underlying autoimmune conditions and immunosuppressant use. mRNA-based vaccines provide a novel approach to establishing immunity against SARS-CoV-2. However, the implications of toll-like receptors (TLRs), type I interferon (IFN) and pro-inflammatory cytokines raise concerns on disease severity and inefficient immune response following mRNA vaccination. The use of immunosuppression to reduce disease activity may have consequential implications on immune responses following SARS-CoV-2 mRNA vaccination. This study systematically reviews the literature on the safety, efficacy, and immunogenicity of SARS-CoV-2 vaccination in patients with autoimmune rheumatic conditions. This comprehensive review was conducted in accordance with the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). A comprehensive literature search on "PubMed" and "EMBASE" electronic databases was conducted to identify relevant articles published from January 1, 2020 to August 31, 2023. The search yielded 106 studies. The mRNA-based vaccines were demonstrated to be safe and efficacious in AIIRD patients. Most studies investigating safety and efficacy of the mRNA-based vaccines reported low frequencies of serious adverse events and disease flares and few breakthrough infections after complete vaccination. Immunogenic response, however, appeared to be blunted in this population of patients, particularly in those who received certain immunosuppressive agents such as methotrexate, mycophenolic acid and rituximab. mRNA-based vaccines are generally safe and efficacious and produce adequate humoral response in AIIRD patients. Additional prospective studies are warranted to ascertain the long-term safety and efficacy profile and the duration of mRNA-vaccine induced immune response. This can aid in shaping guidelines surrounding optimal timing for booster doses in AIIRD patients.
自身免疫性炎性风湿性疾病（AIIRD）患者因潜在的自身免疫性疾病本质和免疫抑制剂的使用而处于免疫功能低下状态，感染严重急性呼吸综合征冠状病毒2（SARS-CoV-2）病毒的风险可能更高，且感染后的预后较差。基于信使核糖核酸（mRNA）的疫苗为建立针对SARS-CoV-2的免疫力提供了一种新方法。然而，Toll样受体（TLR）、I型干扰素（IFN）和促炎细胞因子的影响引发了人们对mRNA疫苗接种后疾病严重程度和免疫反应低效的担忧。使用免疫抑制来降低疾病活动度可能会对SARS-CoV-2 mRNA疫苗接种后的免疫反应产生相应影响。本研究系统回顾了关于自身免疫性风湿性疾病患者接种SARS-CoV-2疫苗的安全性、有效性和免疫原性的文献。本综述按照系统评价和Meta分析的首选报告项目（PRISMA）指南进行。在“PubMed”和“EMBASE”电子数据库中进行了全面的文献检索，以识别2020年1月1日至2023年8月31日发表的相关文章。检索结果为106项研究。基于mRNA的疫苗在AIIRD患者中被证明是安全有效的。大多数调查基于mRNA的疫苗安全性和有效性的研究报告称，严重不良事件和疾病复发的发生率较低，完全接种疫苗后突破性感染很少。然而，这一患者群体的免疫原性反应似乎减弱，尤其是那些接受了某些免疫抑制剂（如甲氨蝶呤、霉酚酸和利妥昔单抗）的患者。基于mRNA的疫苗总体上是安全有效的，并且在AIIRD患者中产生了足够的体液反应。需要进行更多的前瞻性研究，以确定长期安全性和有效性概况以及mRNA疫苗诱导的免疫反应持续时间。这有助于制定关于AIIRD患者加强剂量最佳时机的指南。
