Disease exacerbation and COVID-19 following mRNA COVID-19 vaccination in adolescents with Systemic Lupus Erythematosus
Issued Date
2025-01-01
Resource Type
ISSN
09612033
eISSN
14770962
Scopus ID
2-s2.0-105002004622
Journal Title
Lupus
Rights Holder(s)
SCOPUS
Bibliographic Citation
Lupus (2025)
Suggested Citation
Thepveera S., Charuvanij S., Sukharomana M., Thunsiribuddhichai Y., Lomjansook K., Chaiyapak T., Pattaragarn A., Sumboonnanoda A., Piyaphanee N. Disease exacerbation and COVID-19 following mRNA COVID-19 vaccination in adolescents with Systemic Lupus Erythematosus. Lupus (2025). doi:10.1177/09612033251331244 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/109519
Title
Disease exacerbation and COVID-19 following mRNA COVID-19 vaccination in adolescents with Systemic Lupus Erythematosus
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Corresponding Author(s)
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Abstract
Objectives: To evaluate disease flares and associated factors, as well as the Coronavirus disease 2019 (COVID-19) among adolescents with systemic lupus erythematosus (SLE) after receiving COVID-19 vaccination. Additionally, it sought to determine any difference in year-on-year flare rates before and after vaccination. Methods: We conducted a 12-month prospective study in adolescent SLE (adoSLE) patients aged 12–18 years who had no prior history of COVID-19 and received a 2-dose BNT162b2 mRNA COVID-19 vaccine. A booster dose was administered 4–6 months later, depending on vaccine availability and patient acceptance. Clinical characteristics, the safety of estrogens in lupus erythematosus national assessment-SLE disease activity index (SELENA-SLEDAI) flare index, and renal flare were evaluated and contrasted against pre-vaccination data. COVID-19 during follow-up were noted. Results: Sixty-nine vaccinated adoSLE patients, with the mean age of 15.8 ± 1.6 years and female predominant (92.8%), were included. Forty-six (66.7%) patients received a booster dose at 4-6 months after primary series. Compared between pre- and post- COVID-19 vaccination, year-on-year flare rates remained consistent [20 (29.0%) versus 24 (34.8%), p =.371]. Non-use of hydroxychloroquine (adjusted odds ratio [aOR] 18.83, 95% CI: 1.97, 179.60, p =.011) and a SELENA-SLEDAI score ≥8 within 12 months prior to vaccination (aOR 5.33, 95% CI: 1.38, 20.55, p =.015) were independent factors of disease flares. An increment in post-vaccine renal flare rate was observed [6 (8.7%) versus 14 (20.3%), p =.046]. Among 14 adoSLE patients with renal flare, 13 (92.9%) patients had previous lupus nephritis, and new-onset proteinuria or increased proteinuria (71.4%) was the most common finding. Thirty-four (49.3%) patients contracted COVID-19 within a year post-vaccination, all presenting with mild to moderate symptoms; among the 46 patients who received a booter, 15 (32.6%) experienced COVID-19. Conclusions: COVID-19 vaccination is effective and safe in preventing severe COVID-19 among adoSLE patients, without increasing annual SLE flare rates. However, close monitoring for renal flares is recommended, particularly for patients with a history of LN. Although vaccinated adoSLE patients contracted COVID-19, their outcomes were favorable.