Thepveera Sutheera, Charuvanij Sirirat, Sukharomana Maynart, Thunsiribuddhichai Yanarin, Lomjansook Kraisoon, Chaiyapak Thanaporn, Pattaragarn Anirut, Sumboonnanoda Achra, Piyaphanee Nuntawan
Division of Nephrology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Division of Rheumatology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Lupus. 2025 May;34(6):562-570. doi: 10.1177/09612033251331244. Epub 2025 Mar 29.
ObjectivesTo evaluate disease flares and associated factors, as well as the Coronavirus disease 2019 (COVID-19) among adolescents with systemic lupus erythematosus (SLE) after receiving COVID-19 vaccination. Additionally, it sought to determine any difference in year-on-year flare rates before and after vaccination.MethodsWe conducted a 12-month prospective study in adolescent SLE (adoSLE) patients aged 12-18 years who had no prior history of COVID-19 and received a 2-dose BNT162b2 mRNA COVID-19 vaccine. A booster dose was administered 4-6 months later, depending on vaccine availability and patient acceptance. Clinical characteristics, the safety of estrogens in lupus erythematosus national assessment-SLE disease activity index (SELENA-SLEDAI) flare index, and renal flare were evaluated and contrasted against pre-vaccination data. COVID-19 during follow-up were noted.ResultsSixty-nine vaccinated adoSLE patients, with the mean age of 15.8 ± 1.6 years and female predominant (92.8%), were included. Forty-six (66.7%) patients received a booster dose at 4-6 months after primary series. Compared between pre- and post- COVID-19 vaccination, year-on-year flare rates remained consistent [20 (29.0%) versus 24 (34.8%), = .371]. Non-use of hydroxychloroquine (adjusted odds ratio [aOR] 18.83, 95% CI: 1.97, 179.60, = .011) and a SELENA-SLEDAI score ≥8 within 12 months prior to vaccination (aOR 5.33, 95% CI: 1.38, 20.55, = .015) were independent factors of disease flares. An increment in post-vaccine renal flare rate was observed [6 (8.7%) versus 14 (20.3%), = .046]. Among 14 adoSLE patients with renal flare, 13 (92.9%) patients had previous lupus nephritis, and new-onset proteinuria or increased proteinuria (71.4%) was the most common finding. Thirty-four (49.3%) patients contracted COVID-19 within a year post-vaccination, all presenting with mild to moderate symptoms; among the 46 patients who received a booter, 15 (32.6%) experienced COVID-19.ConclusionsCOVID-19 vaccination is effective and safe in preventing severe COVID-19 among adoSLE patients, without increasing annual SLE flare rates. However, close monitoring for renal flares is recommended, particularly for patients with a history of LN. Although vaccinated adoSLE patients contracted COVID-19, their outcomes were favorable.
目的
评估接种2019冠状病毒病（COVID-19）疫苗后，系统性红斑狼疮（SLE）青少年患者的疾病复发及相关因素，以及COVID-19感染情况。此外，还试图确定接种疫苗前后年复发率的差异。
方法
我们对12至18岁、无COVID-19既往史且接种2剂BNT162b2 mRNA COVID-19疫苗的青少年SLE（adoSLE）患者进行了为期12个月的前瞻性研究。根据疫苗供应情况和患者接受程度，在4至6个月后给予加强剂量。评估临床特征、雌激素在狼疮性肾炎国家评估-SLE疾病活动指数（SELENA-SLEDAI）复发指数中的安全性以及肾脏复发情况，并与接种疫苗前的数据进行对比。记录随访期间的COVID-19感染情况。
结果
纳入69例接种疫苗的adoSLE患者，平均年龄为15.8±1.6岁，以女性为主（92.8%）。46例（66.7%）患者在初次接种系列后4至6个月接受了加强剂量。COVID-19疫苗接种前后相比，年复发率保持一致[20例（29.0%）对24例（34.8%），P = 0.371]。未使用羟氯喹（调整优势比[aOR] 18.83，95%置信区间：1.97，179.60，P = 0.011）以及接种疫苗前12个月内SELENA-SLEDAI评分≥8（aOR 5.33，95%置信区间：1.38，20.55，P = 0.015）是疾病复发的独立因素。观察到疫苗接种后肾脏复发率有所增加[6例（8.7%）对14例（20.3%），P = 0.046]。在14例发生肾脏复发的adoSLE患者中，13例（92.9%）患者既往有狼疮性肾炎，新发蛋白尿或蛋白尿增加（71.4%）是最常见的表现。34例（49.3%）患者在接种疫苗后一年内感染了COVID-19，均表现为轻至中度症状；在46例接受加强剂量的患者中，15例（32.6%）感染了COVID-19。
结论
COVID-19疫苗接种在预防adoSLE患者发生重症COVID-19方面有效且安全，不会增加SLE年复发率。然而，建议密切监测肾脏复发情况，尤其是有狼疮性肾炎病史的患者。尽管接种疫苗的adoSLE患者感染了COVID-19，但其预后良好。
