The continuing coronavirus disease 2019 (COVID-19) pandemic, which was triggered by a rapid epidemic of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has had a significant impact on the worldwide economy and healthcare system. The COVID-19 vaccine has been shown to be successful in containing the pandemic.
A recent RMD Open journal article investigates the risk of COVID-19 and the probability of severe consequences in SLE patients and the general population. This study also looked at how the COVID-19 vaccine affected both groups.
Introduction Immune dysfunction, elevated levels of COVID-19 binding receptors, immunosuppressive treatment, and frequent comorbidities such as renal and cardiovascular illness all contribute to poor outcomes in SLE patients. Despite the fact that many researchers have looked into the risk of COVID-19 in SLE patients, the results have been inconsistent.
Because the majority of these studies were conducted prior to the availability of COVID-19 vaccinations, it is critical to determine how immunization increases the risk of severe COVID-19 sequelae in SLE patients. Additionally, research on SARS-CoV-2 breakthrough infection and the risk of sequelae in SLE patients is lacking.
Concerning the research
The current study drew on data from The Health Improvement Network (THIN), an electronic medical record database of general practitioners (GPs) in the United Kingdom. THIN collects medical, anthropometric, lifestyle, and sociodemographic information from around 17 million UK residents.
Two retrospective cohorts were compared in this study to estimate the risk of SARS-CoV-2 infection, hospitalization, and death among SLE patients and the general population based on their COVID-19 vaccination status.
The read code collected from GPs was used to diagnose SLE. A read code is obtained only after hospital specialists confirm the diagnosis.
Participants in the study were to be between the ages of 18 and 90 between December 8, 2020, and October 31, 2021. There was no previous SARS-CoV-2 infection among the trial subjects.
The study’s findings
The unvaccinated cohort included 3,245 SLE patients and 1,755,034 people in the general population. The vaccination group included 2,860 SLE patients and 1,388,093 people from the general population.
SLE patients were older, with a larger proportion of women than men. SLE patients used healthcare services more frequently than the general population, such as GP consultations or hospitalization.
Prior to receiving the COVID-19 vaccine, people with SLE had a much higher risk of COVID-19 and its severe consequences than the general population. There was no statistical difference in the risk of SARS-CoV-2 breakthrough infection and severe sequelae between the two trial groups after vaccination. This finding emphasizes the significance of COVID-19 vaccination in SLE patients, as it lowers the probability of severe COVID-19 and its associated sequelae. Yet, even after vaccination, some SLE patients, particularly those taking B-cell depletion therapy, may be at high risk of SARS-CoV-2 infection.
Strengths and weaknesses
The current study has various benefits, including the use of real-world data to estimate the risk of COVID-19 breakthrough infection and its consequences following COVID-19 immunization in SLE patients. Another advantage of this study is that it reduces the impact of potential confounding factors such as lifestyle, social determinants of health, gender, and age.
One of the study’s shortcomings was the investigators’ inability to establish the impact of biological immunoregulatory and immunosuppressive medicines on the likelihood of SARS-CoV-2 infection and related sequelae. SLE patients with severe symptoms, such as lupus nephritis, as well as those who require intense immunosuppression, such as high doses of rituximab, glucocorticoids, and mycophenolate, typically have lower vaccine immunogenicity. Even after immunization, these patients would be at a higher risk of COVID-19.
To better understand the influence of COVID-19 and vaccinations on SLE patients, a bigger cohort with a longer follow-up time is required. Although the frequency and types of healthcare utilizations were changed, other behavioral aspects such as the use of facemasks and hand sanitizers were not taken into account.
After vaccination, there were no significant differences in the risk of developing COVID-19, hospitalization, or death between SLE patients and the general population. The findings of the study highlight the relevance of COVID-19 immunization among SLE patients in order to prevent breakthrough infection and severe sequelae.
Further study is needed in the future to focus on SLE patients receiving immunosuppressive medications and how these people can be safeguarded from COVID-19.