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Systemic lupus erythematosus in the light of the COVID-19 pandemic: infection, vaccination, and impact on disease management.

Authors
  • Mehta, Pankti1
  • Gasparyan, Armen Yuri2
  • Zimba, Olena3
  • Kitas, George D4, 5
  • 1 Department of Clinical Immunology and Rheumatology, King George's Medical University, Lucknow, India. , (India)
  • 2 Departments of Rheumatology and Research and Development, Dudley Group NHS Foundation Trust (Teaching Trust of the University of Birmingham, UK), Russells Hall Hospital, Pensnett Road, Dudley, DY1 2HQ, UK. [email protected]
  • 3 Department of Internal Medicine N2, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine. , (Ukraine)
  • 4 Departments of Rheumatology and Research and Development, Dudley Group NHS Foundation Trust (Teaching Trust of the University of Birmingham, UK), Russells Hall Hospital, Pensnett Road, Dudley, DY1 2HQ, UK.
  • 5 Centre for Epidemiology Versus Arthritis, University of Manchester, Manchester, UK.
Type
Published Article
Journal
Clinical Rheumatology
Publisher
Springer-Verlag
Publication Date
May 31, 2022
Identifiers
DOI: 10.1007/s10067-022-06227-7
PMID: 35639259
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Patients with systemic lupus erythematosus (SLE) form a vulnerable group in terms of the impact of the COVID-19 pandemic on disease management. We conducted this overview by searches through Medline/PubMed, Scopus, and the Directory of Open Access Journals (DOAJ). The prevalence and severity of COVID-19, efficacy of COVID-19 vaccination, impact on the management of SLE, and the attitudes of SLE patients to COVID-19 and vaccination were explored. After screening and due exclusions, 198 studies were included for the final review. Patients with SLE have a greater risk of acquiring COVID-19 (0.6-22%) and related hospitalization (30%), severe disease (13.5%), and death (6.5%) than the general population. Older age, male gender, comorbidities, moderate or high disease activity, and glucocorticoid, rituximab, and cyclophosphamide use are associated with unfavorable outcomes, whereas methotrexate and belimumab use showed no association with outcomes. COVID-19 vaccines are safe in SLE with minimal risk of severe flares (< 2%). Vaccine efficacy is negatively associated with glucocorticoids. The overall attitude of patients towards vaccination is positive (54-90%). The pandemic has negatively affected access to medical care, hospitalizations, procurement of drugs, employment, and the mental health of patients which need to be addressed as part of holistic care in SLE. Key Points • Lupus patients are at a greater risk of acquiring COVID-19, related hospitalization, severe disease, and death than the general population. • COVID-19 vaccines are relatively safe for lupus patients with minimal risk of severe flares. • Lupus patients' attitude towards COVID-19 vaccination is predominantly positive. © 2022. The Author(s), under exclusive licence to International League of Associations for Rheumatology (ILAR).

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