Acceptance, tolerability, and effect of COVID-19 vaccination on disease activity in a cohort of Egyptian systemic lupus erythematosus patients: Real-life experience
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Keywords

Lupus, COVID, Vaccine, Flare

How to Cite

Abu-Zaid, M., Aly, H., Moshrif, A., Noor, R., & El-Ghobashy, N. (2023). Acceptance, tolerability, and effect of COVID-19 vaccination on disease activity in a cohort of Egyptian systemic lupus erythematosus patients: Real-life experience. Rheumatology (Bulgaria), 31(3), 30-37. https://doi.org/10.35465/31.3.2023.pp30-37

Abstract

Abstract

Objective: To assess the tolerance and effects of COVID-19 vaccination in Egyptian patients with systemic lupus erythematosus (SLE), such as incident flare risk, based on the patient’s perspective.

Methods: SLE patients were included in this multicenter cross-sectional questionnaire-based analysis. Data included demographic and clinical features, prior COVID-19 infection, vaccine acceptability, type of vaccination, disease status before and after vaccination, and related side effects.

Results: The total number of patients included was 230. Ages ranged from 18 to 64 years, disease duration from 1 to 15 years, and 92.6% were females. Only 31.7% of the study population were COVID-infected; most (70.7%) were treated at home, while 1.2% needed ICU. In contrast, 53% of our patients were vaccinated, and 47% were not vaccinated, primarily due to fear of side effects or disease flare. After the first dose of vaccination, 44.1% reported vaccine-related side effects, of which fatigue, fever, myalgia, as well as injection site reaction were the prevalent complications. The highest incidence of side effects was in AstraZeneca (78%), while the least was in Sinopharm (29.6%). 16.3% of vaccinated patients were COVID infected after vaccination, and 88.2% were treated at home. Only 14.6% of the vaccinated population experienced a lupus flare, primarily after the first dose, with no significant difference between the type of vaccine and lupus flares.

Conclusion: The acceptance of COVID-19 vaccination among our lupus patients was neutral. The observed adverse effects were comparable to those reported by healthy individuals. Post-vaccination lupus flares were infrequent and unrelated to the vaccine type but rather to the pre-vaccination disease activity state.

Keywords: Lupus, COVID, Vaccine, Flare

https://doi.org/10.35465/31.3.2023.pp30-37
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References

  1. D’Silva KM, Jorge A, Cohen A, McCormick N, Zhang Y, Wallace ZS, et al. COVID‐19 outcomes in patients with systemic autoimmune rheumatic diseases compared to the general population: a US multicenter, comparative cohort study. Arthritis & rheumatology. 2021;73(6):914-20.
  2. Figueroa-Parra G, Esquivel-Valerio JA, Santoyo-Fexas L, Moreno-Salinas A, Gamboa-Alonso CM, De Leon-Ibarra AL, et al. Knowledge and attitudes about influenza vaccination in rheumatic diseases patients. Human Vaccines & Immunotherapeutics. 2021;17(5):1420-5.
  3. Moraliyska R, Georgiev T, Bogdanova-Petrova S, Shivacheva T. Adoption rates of recommended vaccines and influencing factors among patients with inflammatory arthritis: a patient survey. Rheumatology International. 2023:1-8.
  4. Baden LR, El Sahly HM, Essink B, Kotloff K, Frey S, Novak R, et al. Efficacy and safety of the mRNA-1273 SARS-CoV-2 vaccine. New England journal of medicine. 2021;384(5):403-16.
  5. Felten R, Dubois M, Ugarte-Gil MF, Chaudier A, Kawka L, Bergier H, et al. Vaccination against COVID-19: expectations and concerns of patients with autoimmune and rheumatic diseases. The Lancet Rheumatology. 2021;3(4):e243-e5.
  6. Priori R, Pellegrino G, Colafrancesco S, Alessandri C, Ceccarelli F, Di Franco M, et al. SARS-CoV-2 vaccine hesitancy among patients with rheumatic and musculoskeletal diseases: a message for rheumatologists. Annals of the rheumatic diseases. 2021;80(7):953-4.
  7. Geisen UM, Berner DK, Tran F, Sümbül M, Vullriede L, Ciripoi M, et al. Immunogenicity and safety of anti-SARS-CoV-2 mRNA vaccines in patients with chronic inflammatory conditions and immunosuppressive therapy in a monocentric cohort. Annals of the rheumatic diseases. 2021;80(10):1306-11.
  8. Ramasamy MN, Minassian AM, Ewer KJ, Flaxman AL, Folegatti PM, Owens DR, et al. Safety and immunogenicity of ChAdOx1 nCoV-19 vaccine administered in a prime-boost regimen in young and old adults (COV002): a single-blind, randomised, controlled, phase 2/3 trial. The Lancet. 2020;396(10267):1979-93.
  9. Hochberg MC. Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus. Arthritis and rheumatism. 1997;40(9):1725-.
  10. Petri M, Orbai AM, Alarcón GS, Gordon C, Merrill JT, Fortin PR, et al. Derivation and validation of the Systemic Lupus International Collaborating Clinics classification criteria for systemic lupus erythematosus. Arthritis & Rheumatism. 2012;64(8):2677-86.
  11. Aringer M, Costenbader K, Daikh D, Brinks R, Mosca M, Ramsey‐Goldman R, et al. 2019 European League Against Rheumatism/American College of Rheumatology classification criteria for systemic lupus erythematosus. Arthritis & rheumatology. 2019;71(9):1400-12.
  12. organization Wh. WHO Corona virus dashboard 2023 [updated 16 Agust 2023. Available from: https://covid19.who.int/.
  13. Ahmed S, Zimba O, Gasparyan AY. COVID-19 and the clinical course of rheumatic manifestations. Clinical Rheumatology. 2021:1-9.
  14. Mehta P, Gasparyan AY, Zimba O, Kitas GD. Systemic lupus erythematosus in the light of the COVID-19 pandemic: infection, vaccination, and impact on disease management. Clinical Rheumatology. 2022;41(9):2893-910.
  15. Gianfrancesco M, Hyrich KL, Al-Adely S, Carmona L, Danila MI, Gossec L, et al. Characteristics associated with hospitalisation for COVID-19 in people with rheumatic disease: data from the COVID-19 Global Rheumatology Alliance physician-reported registry. Annals of the rheumatic diseases. 2020;79(7):859-66.
  16. Tang K-T, Hsu B-C, Chen D-Y. Autoimmune and Rheumatic Manifestations Associated With COVID-19 in Adults: An Updated Systematic Review. Frontiers in immunology. 2021;12:628.
  17. Curtis JR, Johnson SR, Anthony DD, Arasaratnam RJ, Baden LR, Bass AR, et al. American College of Rheumatology guidance for COVID‐19 vaccination in patients with rheumatic and musculoskeletal diseases: version 3. Arthritis & Rheumatology. 2021;73(10):e60-e75.
  18. Landewé RB, Kroon FP, Alunno A, Najm A, Bijlsma JW, Burmester G-RR, et al. EULAR recommendations for the management and vaccination of people with rheumatic and musculoskeletal diseases in the context of SARS-CoV-2: the November 2021 update. Annals of the rheumatic diseases. 2022;81(12):1628-39.
  19. Dhamanti I, Suwantika AA, Adlia A, Yamani LN, Yakub F. Adverse Reactions of COVID-19 Vaccines: A Scoping Review of Observational Studies. International Journal of General Medicine. 2023:609-18.
  20. Tang W, Gartshteyn Y, Ricker E, Inzerillo S, Murray S, Khalili L, et al. The use of COVID-19 vaccines in patients with SLE. Current Rheumatology Reports. 2021;23:1-12.
  21. González-Meléndez A, Báez-Negrón L, Ríos-Rivera R, Franco-O’Connell AS, Nieves-Plaza M, Vilá LM. Short-and mid-term outcomes in systemic lupus erythematosus patients presenting with disease exacerbation after SARS-CoV-2 mRNA vaccination: A cohort study from Puerto Rico. Lupus. 2023:09612033231151898.
  22. Felten R, Kawka L, Dubois M, Ugarte-Gil MF, Fuentes-Silva Y, Piga M, et al. Tolerance of COVID-19 vaccination in patients with systemic lupus erythematosus: the international VACOLUP study. The Lancet Rheumatology. 2021;3(9):e613-e5.
  23. Chen J, Cai W, Liu T, Zhou Y, Jin Y, Yang Y, et al. The COVID-19 vaccine: Attitudes and vaccination in patients with autoimmune inflammatory rheumatic diseases. Rheumatology & Autoimmunity. 2022;2(02):82-91.
  24. Rezende RPV, Braz AS, Guimarães MFB, Ribeiro SLE, Vieira RMRA, Bica BE, et al. Characteristics associated with COVID-19 vaccine hesitancy: a nationwide survey of 1000 patients with immune-mediated inflammatory diseases. Vaccine. 2021;39(44):6454-9.
  25. Sattui SE, Liew JW, Kennedy K, Sirotich E, Putman M, Moni TT, et al. Early experience of COVID-19 vaccination in adults with systemic rheumatic diseases: results from the COVID-19 Global Rheumatology Alliance Vaccine Survey. RMD open. 2021;7(3):e001814.
  26. Bartels LE, Ammitzbøll C, Andersen JB, Vils SR, Mistegaard CE, Johannsen AD, et al. Local and systemic reactogenicity of COVID-19 vaccine BNT162b2 in patients with systemic lupus erythematosus and rheumatoid arthritis. Rheumatology international. 2021;41(11):1925-31.
  27. Polack FP, Thomas SJ, Kitchin N, Absalon J, Gurtman A, Lockhart S, et al. Safety and efficacy of the BNT162b2 mRNA Covid-19 vaccine. New England journal of medicine. 2020;383(27):2603-15.
  28. Oh TH, Woo SH, Hong S, Lee C, Lee WJ, Jeong SK. Clinical features of patients presenting to the emergency department with cardiovascular adverse reactions after COVID-19 mRNA vaccination. Journal of Korean medical science. 2022;37(9).
  29. Menni C, Klaser K, May A, Polidori L, Capdevila J, Louca P, et al. Vaccine side-effects and SARS-CoV-2 infection after vaccination in users of the COVID Symptom Study app in the UK: a prospective observational study. The Lancet Infectious Diseases. 2021;21(7):939-49.
  30. Bsoul EA, Loomer PM. COVID-19 vaccination experience among United States dental professionals and students: Safety, confidence, concerns, and side effects. PloS one. 2022;17(2):e0264323.
  31. Ganesan S, Al Ketbi LMB, Al Kaabi N, Al Mansoori M, Al Maskari NN, Al Shamsi MS, et al. Vaccine side effects following COVID-19 vaccination among the residents of the UAE—An Observational study. Frontiers in public health. 2022;10.
  32. Perrotta A, Biondi-Zoccai G, Saade W, Miraldi F, Morelli A, Marullo AG, et al. A snapshot global survey on side effects of COVID-19 vaccines among healthcare professionals and armed forces with a focus on headache. Panminerva Medica. 2021;63(3):324-31.
  33. Orebi HA, Emara HE, Alhindi AA, Shahin MR, Hegazy AH, Kabbash IA, et al. Perceptions and experiences of COVID-19 vaccines’ side effects among healthcare workers at an Egyptian University Hospital: a cross-sectional study. Tropical medicine and health. 2022;50(1):37.
  34. Elgendy MO, El-Gendy AO, Mahmoud S, Mohammed TY, Abdelrahim ME, Sayed AM. Side effects and efficacy of COVID-19 vaccines among the Egyptian population. Vaccines. 2022;10(1):109.
  35. Jiang X, Sparks J, Wallace Z, Deng X, Li H, Lu N, et al. Risk of COVID-19 among unvaccinated and vaccinated patients with systemic lupus erythematosus: a general population study. RMD open. 2023;9(1):e002839.
  36. Aboud FM, Hussein RS, El Bably MM, Hassan RM. COVID-19 VACCINE IN EGYPTIAN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS, RHEUMATOID ARTHRITIS AND OTHER RHEUMATIC DISEASES. Ain Shams Medical Journal. 2023;74(1):21-32.
  37. So H, Li T, Chan V, Tam L-S, Chan PK. Immunogenicity and safety of inactivated and mRNA COVID-19 vaccines in patients with systemic lupus erythematosus. Therapeutic advances in musculoskeletal disease. 2022;14:1759720X221089586.
  38. Pugès M, Biscay P, Barnetche T, Truchetet M-É, Richez C, Seneschal J, et al. Immunogenicity and impact on disease activity of influenza and pneumococcal vaccines in systemic lupus erythematosus: a systematic literature review and meta-analysis. Rheumatology. 2016;55(9):1664-72.
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