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2024-03-21T17:11:45.000Z

Association between history of vaccination and the development of SLE

Mar 21, 2024
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Learning objective: After reading this article, learners will be able to cite a new clinical development in systemic lupus erythematosus.

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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.

Key learnings

  • Overall, a history of vaccinations was not significantly associated with an increased risk of SLE.
  • While there was potential association between hepatitis B vaccination and risk of SLE, more recent evidence is needed to confirm this association, given the included studies were conducted 1–2 decades ago.
  • The results provide evidence supporting normal use of vaccination in patients with SLE, mitigating concerns about the development of SLE, and endorsing continued efforts in vaccine development.

  1. Wang M, Gu H, Zhai Y, et al. Vaccination and the risk of systemic lupus erythematosus: a meta-analysis of observational studies. Arthritis Res Ther. 2024;26(1):60. DOI: 1186/s13075-024-03296-8

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