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Review
. 2023 Sep 4;11(9):1456.
doi: 10.3390/vaccines11091456.

Efficacy, Immunogenicity, and Safety of COVID-19 Vaccines in Patients with Autoimmune Diseases: A Systematic Review and Meta-Analysis

Alvina Widhani  1   2 , Anshari Saifuddin Hasibuan  1 , Retia Rismawati  1 , Suzy Maria  1 , Sukamto Koesnoe  1 , Muhammad Ikrar Hermanadi  1 , Youdiil Ophinni  3   4   5 , Chika Yamada  5 , Kuntjoro Harimurti  6 , Aldean Nadhyia Laela Sari  1 , Evy Yunihastuti  1 , Samsuridjal Djauzi  1
Affiliations
Review

Efficacy, Immunogenicity, and Safety of COVID-19 Vaccines in Patients with Autoimmune Diseases: A Systematic Review and Meta-Analysis

Alvina Widhani et al. Vaccines (Basel). .

Abstract

Patients with autoimmune diseases are among the susceptible groups to COVID-19 infection because of the complexity of their conditions and the side effects of the immunosuppressive drugs used to treat them. They might show impaired immunogenicity to COVID-19 vaccines and have a higher risk of developing COVID-19. Using a systematic review and meta-analysis, this research sought to summarize the evidence on COVID-19 vaccine efficacy, immunogenicity, and safety in patients with autoimmune diseases following predefined eligibility criteria. Research articles were obtained from an initial search up to 26 September 2022 from PubMed, Embase, EBSCOhost, ProQuest, MedRxiv, bioRxiv, SSRN, EuroPMC, and the Cochrane Center of Randomized Controlled Trials (CCRCT). Of 76 eligible studies obtained, 29, 54, and 38 studies were included in systematic reviews of efficacy, immunogenicity, and safety, respectively, and 6, 18, and 4 studies were included in meta-analyses for efficacy, immunogenicity, and safety, respectively. From the meta-analyses, patients with autoimmune diseases showed more frequent breakthrough COVID-19 infections and lower total antibody (TAb) titers, IgG seroconversion, and neutralizing antibodies after inactivated COVID-19 vaccination compared with healthy controls. They also had more local and systemic adverse events after the first dose of inactivated vaccination compared with healthy controls. After COVID-19 mRNA vaccination, patients with autoimmune diseases had lower TAb titers and IgG seroconversion compared with healthy controls.

Keywords: COVID-19; autoimmune; efficacy; immunogenicity; safety; vaccine.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
PRISMA flow chart.
Figure 2
Figure 2
Breakthrough COVID-19 infections after receiving primary doses (two doses) of COVID-19 inactivated vaccine. Blue squares represent effect sizes for a single study, and black rhombus represent pooled results for all studies [72,75,76,77].
Figure 3
Figure 3
Breakthrough COVID-19 infections from studies using mRNA and adenovirus viral vector COVID 19 vaccines. Blue squares represent effect sizes for a single study, and black rhombus represent pooled results for all studies [97,98].
Figure 4
Figure 4
Log TAb titer after mRNA vaccination. Green squares represent effect sizes for a single study, and black rhombus represent pooled results for all studies [8,35,36,43,50,61,101].
Figure 5
Figure 5
Log TAb titer after inactivated vaccination. Green squares represent effect sizes for a single study, and black rhombus represent pooled results for all studies [72,75,76,80,83].
Figure 6
Figure 6
IgG seroconversion after mRNA vaccination. Blue squares represent effect sizes for a single study, and black rhombus represent pooled results for all studies [8,35,36,43,50,52,54,61,62,65,101].
Figure 7
Figure 7
IgG seroconversion after inactivated vaccination. Blue squares represent effect sizes for a single study, and black rhombus represent pooled results for all studies [72,74,75,76,77,80,83].
Figure 8
Figure 8
Proportion of neutralizing antibodies positive after mRNA vaccination. Blue squares represent effect sizes for a single study, and black rhombus represent pooled results for all studies [50,54,62].
Figure 9
Figure 9
Proportion of neutralizing antibodies positive after inactivated vaccination. Blue squares represent effect sizes for a single study, and black rhombus represent pooled results for all studies [72,74,75,76,77,80,83].
Figure 10
Figure 10
Neutralizing activity after inactivated vaccination. Green squares represent effect sizes for a single study, and black rhombus represent pooled results for all studies [72,75,76,77,80,83].
Figure 11
Figure 11
Local adverse events after receiving a first dose of COVID-19 inactivated vaccine. Blue squares represent effect sizes for a single study, and black rhombus represent pooled results for all studies [72,75,76,77].
Figure 12
Figure 12
Local adverse events after receiving a second dose of COVID-19 inactivated vaccine. Blue squares represent effect sizes for a single study, and black rhombus represent pooled results for all studies [72,75,76,77].
Figure 13
Figure 13
Systemic adverse events after receiving a first dose of COVID-19 inactivated vaccine. Blue squares represent effect sizes for a single study, and black rhombus represent pooled results for all studies [72,75,76,77].
Figure 14
Figure 14
Systemic adverse events after receiving a second dose of COVID-19 inactivated vaccine. Blue squares represent effect sizes for a single study, and black rhombus represent pooled results for all studies [72,75,76,77].
See this image and copyright information in PMC

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