COVID-19 Vaccination Benefits Patients With Systemic Lupus Erythematosus

In a study published in Vaccines, investigators evaluated the safety and clinical impact of vaccination against COVID-19 for patients with systemic lupus erythematosus (SLE). They found that vaccination did have a favorable safety profile for this patient population, and although the analysis of disease activity varied across platform, there was an increased proportion of disease activity for those receiving ChAdOx-1 (Oxford-AstraZeneca) compared with Sinovac-CoronaVac (Sinovac) and BNT162b2 (Pfizer-BioNTech).¹

“We reported the presence of vaccine-related adverse events in these individuals both after the first dose and subsequent doses,” the study authors wrote. “However, non-severe events were more frequent, primarily related to symptoms at the injection site, followed by systemic symptoms such as headache, musculoskeletal complaints, and fatigue, with no hospitalizations or deaths recorded.”

ChAdOx-1 is a recombinant that is a replication-deficient adenoviral vector vaccine, according to the World Health Organization (WHO). The efficacy in trials for patients who have the full 2-dose series is approximately 63.1% based on a median follow-up of 80 days. Sinovac as a 2-dose regimen has shown an approximate efficacy of 51% against symptomatic infection, 100% against severe infection, and 100% against hospitalization starting 14 days after the second dose. However, WHO noted that the safety data was limited for patients 60 years and older.^2,3

As for the Pfizer-BioNTech vaccine, WHO stated that the immunization has been highly efficacious against severe disease with moderate efficacy against symptomatic infection. For safety, there were rare events of myocarditis after the second dose, which mainly occurred in male patients aged 18 to 35 years old.⁴

Investigators of the current study used a real-world study to assess the postmarketing safety and effectiveness of COVID-19 vaccines for patients with SLE. There were 1215 patients included in the study, with 373 patients who had SLE. Of the patients with SLE, 209 received initial vaccination with 2 doses of Sinovac, 132 received ChAdOx-1, and 32 received Pfizer-BioNTech. Approximately 89.81% of patients were women with a mean age of 36 years. Approximately 52.55% were mixed race, 39.56% were white, 14.48% were Black, 2.14% were Asian, and 9.28% were Indigenous.¹

Injection site, followed by headache and fatigue, was considered the most commonly reported adverse event. For different vaccines, there was a significant difference observed after the first dose for patients who received ChAdOx-1 compared with the inactive virus vaccines. After the second dose, the trend only continued for local symptoms, with a higher number also occurring for those who received ChAdOx-1.¹

“Concern regarding the impact of vaccines on the risk of disease exacerbation is one of the main reasons for vaccine hesitancy among individuals with immune-mediated diseases, both from healthcare providers and the patients themselves,” the study investigators said.¹ “We identified a significant increase in the proportion of individuals with moderate to high disease activity among patients who received the initial vaccination schedule with ChadOx-1, contrasting with a reduction in the proportion of patients with moderate to high disease activity and an increased remission rate in those vaccinated with CoronaVac.”

Of the 373 patients, 9 patients reported COVID-19 after 15 days postvaccination with the first dose. Further, 44 cases from 15 days after the second dose up to 12 months were seen as well as with the period immediately before the fourth dose of the vaccine. For the patients with infection, 8 sought emergency medical care, but only 1 patient required hospitalization. There were no statistically significant differences in the number of new COVID-19 cases for different vaccines.¹

“Vaccine safety appears to be well established, and concerning the risks of exacerbation, they are reported in studies but do not outweigh the benefits of immunization,” the study authors said.¹ “The discussion about the optimal timing of vaccination is important due to prior evidence indicating a higher risk of post-vaccination exacerbation in individuals with active disease.”

READ MORE: COVID-19 Resource Center

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REFERENCES

1. Sartori NS, Machado KLLL, Miyamoto ST, et al. Impact of SARS-CoV-2 Vaccination on Disease Activity and Severity of COVID-19 Infection in Patients with Systemic Lupus Erythematosus: A Multicenter Cohort Study. Vaccines (Basel). 2025;13(10):1074. Published 2025 Oct 21. doi:10.3390/vaccines13101074

2. World Health Organization. AstraZeneca ChAdOx1-S/nCoV-19 [recombinant], COVID-19 vaccine. May 10, 2021. Accessed October 30, 2025. https://www.who.int/publications/m/item/chadox1-s-recombinant-covid-19-vaccine

3. World Health Organization. The Sinovac-CoronaVac COVID-19 vaccine: what you need to know. June 10, 2022. Accessed October 30, 2025. https://www.who.int/news-room/feature-stories/detail/the-sinovac-covid-19-vaccine-what-you-need-to-know

4. World Health Organization. The Pfizer BioNTech (BNT162b2) COVID-19 vaccine: what you need to know. August 18, 2022. Accessed October 30, 2025. https://www.who.int/news-room/feature-stories/detail/the-sinovac-covid-19-vaccine-what-you-need-to-know