[Should we vaccinate patients with systemic lupus]

Area of Science:

• Immunology
• Rheumatology
• Vaccinology

Context:

• Systemic lupus erythematosus (SLE) patients face significant infection risks, often outweighing concerns about vaccine-induced exacerbations.
• Decades-long debates persist regarding the safety and efficacy of immunizations in SLE management.
• Infections remain a primary cause of morbidity and mortality in individuals with SLE.

Purpose:

• To review current evidence on the safety and efficacy of vaccines in patients with SLE.
• To guide clinicians in determining appropriate vaccination strategies for SLE patients.
• To address concerns about potential SLE flares following immunization.

Summary:

• Inactivated vaccines appear safe for SLE patients with stable disease, while live vaccines are contraindicated for those who are immunocompromised or on high-dose steroids.
• Efficacy data for vaccines, particularly influenza and pneumococcal vaccines, are limited, with most SLE patients mounting an immune response, though some do not.
• The review highlights the need for further research into factors influencing vaccine response and the potential utility of post-vaccination antibody titer assessment.

Impact:

• Provides evidence-based guidance for clinicians managing SLE patients.
• Aims to improve vaccination rates and reduce infection-related complications in SLE.
• Contributes to a better understanding of vaccine immunology in autoimmune diseases.