Association between history of vaccination and the development of SLE

Patients with systemic lupus erythematosus (SLE) commonly experience immunosuppression, either as a result of the original disease or treatment for SLE; often leading to an increased risk of infections. In the general population, vaccinations are commonplace as prophylactic measures for infection. However, concerns over a possible link between the development or exacerbation of SLE following vaccination has led to uncertainty over administering vaccines in patients with SLE.

Here, we summarize a meta-analysis by Wang et al.¹ published in Arthritis Research & Therapy on the association and risk for the development of SLE following vaccination.

Methods¹

• A systematic literature search was performed for cohort or case-control studies from inception to September 3, 2023.
• The incidence and risk for SLE following vaccination was analyzed by vaccination type, geographical region, and overall incidence in the total population.
• The adjusted odds ratios (OR) and 95% confidence intervals (CI) from each trial were used to analyze the association between history of vaccination and risk of SLE.

Key findings¹

• A total of 17 studies, comprising 45,067,349 patients who received a vaccination, were included in this meta-analysis.
  • Follow-up periods ranged from 0.5 to 2 years post-vaccination.
• In the pooled population, a history of vaccination was not found to be significantly associated with increased risk of SLE (p = 0.348) (Figure 1).
• In a subgroup analysis by vaccination type:
  • hepatitis B was the sole vaccination found to be significantly associated with increased risk of SLE;
  • the human papillomavirus vaccination also showed a slight increase in OR, but this difference was not significant; and
  • the COVID-19 vaccination was associated with a slightly decreased risk of SLE; however, also not significant.

Figure 1. Odds ratio for SLE by history of vaccination*

CI, confidence interval; HBV, hepatitis B; HPV, human papillomavirus.
*Data from Wang, et al.¹

• In a subgroup analysis by geographical region, a history of vaccination was marginally associated with the risk of SLE in the following regions:
  • North America: OR, 1.87 (95% CI, 0.99–3.52; p = 0.053)
  • Europe: OR, 0.96 (95% CI, 0.84–1.10; p = 0.551)
  • Asia: OR, 0.79 (95% CI, 0.30–2.07; p = 0.628)
• None of the significant associations identified in the individual studies or by subgroup analysis reversed the pooled effect of no association between vaccination and the development of SLE.