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Risk of Flare or Relapse in Patients With Immune-Mediated Diseases Following Sars-Cov-2 Vaccination: A Systematic Review and Meta-Analysis Publisher Pubmed



Shabani M1 ; Shobeiri P1, 2, 3, 4 ; Nouri S5 ; Moradi Z6 ; Amenu RA6 ; Mehrabi Nejad MM7 ; Rezaei N3, 4
Authors
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Authors Affiliations
  1. 1. School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
  2. 2. Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
  3. 3. Department of Immunology, Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children’s Medical Center, Tehran University of Medical Sciences, Qarib St, Keshavarz Blvd, 14194, Tehran, 1419733141, Iran
  4. 4. Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tehran, Iran
  5. 5. Arak University of Medical Sciences, Arak, Iran
  6. 6. Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
  7. 7. Department of Radiology, School of Medicine, Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Imam Khomeini Hospital, Tehran University of Medical Sciences (TUMS), Qarib St, Keshavarz Blvd, 14194, Tehran, 1419733141, Iran

Source: European Journal of Medical Research Published:2024


Abstract

Background: Patients with autoimmune and immune-mediated diseases (AI-IMD) are at greater risk of COVID-19 infection; therefore, they should be prioritized in vaccination programs. However, there are concerns regarding the safety of COVID-19 vaccines in terms of disease relapse, flare, or exacerbation. In this study, we aimed to provide a more precise and reliable vision using systematic review and meta-analysis. Methods: PubMed-MEDLINE, Embase, and Web of Science were searched for original articles reporting the relapse/flare in adult patients with AI-IMD between June 1, 2020 and September 25, 2022. Subgroup analysis and sensitivity analysis were conducted to investigate the sources of heterogeneity. Statistical analysis was performed using R software. Results: A total of 134 observations of various AI-IMDs across 74 studies assessed the rate of relapse, flare, or exacerbation in AI-IMD patients. Accordingly, the crude overall prevalence of relapse, flare, or exacerbation was 6.28% (95% CI [4.78%; 7.95%], I 2 = 97.6%), changing from 6.28% (I 2 = 97.6%) to 6.24% (I 2 = 65.1%) after removing the outliers. AI-IMD patients administering mRNA, vector-based, and inactive vaccines showed 8.13% ([5.6%; 11.03%], I 2 = 98.1%), 0.32% ([0.0%; 4.03%], I 2 = 93.5%), and 3.07% ([1.09%; 5.9%], I 2 = 96.2%) relapse, flare, or exacerbation, respectively (p-value = 0.0086). In terms of disease category, nephrologic (26.66%) and hematologic (14.12%) disorders had the highest and dermatologic (4.81%) and neurologic (2.62%) disorders exhibited to have the lowest crude prevalence of relapse, flare, or exacerbation (p-value < 0.0001). Conclusion: The risk of flare/relapse/exacerbation in AI-IMD patients is found to be minimal, especially with vector-based vaccines. Vaccination against COVID-19 is recommended in this population. © 2024, The Author(s).
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