Disease exacerbation and COVID-19 following mRNA COVID-19 vaccination in adolescents with Systemic Lupus Erythematosus

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.