Acceptance, tolerability, and effect of COVID-19 vaccination on disease activity in a cohort of Egyptian systemic lupus erythematosus patients: Real-life experience

Abstract Objective: To assess the tolerance and effects of COVID-19 vaccination in Egyptian patients with systemic lupus erythematosus (SLE), such as incident flare risk, based on the patient’s perspective. Methods: SLE patients were included in this multicenter cross-sectional questionnaire-based analysis. Data included demographic and clinical features, prior COVID-19 infection, vaccine acceptability, type of vaccination, disease status before and after vaccination, and related side effects. Results: The total number of patients included was 230. Ages ranged from 18 to 64 years, disease duration from 1 to 15 years, and 92.6% were females. Only 31.7% of the study population were COVID-infected; most (70.7%) were treated at home, while 1.2% needed ICU. In contrast, 53% of our patients were vaccinated, and 47% were not vaccinated, primarily due to fear of side effects or disease flare. After the first dose of vaccination, 44.1% reported vaccine-related side effects, of which fatigue, fever, myalgia, as well as injection site reaction were the prevalent complications. The highest incidence of side effects was in AstraZeneca (78%), while the least was in Sinopharm (29.6%). 16.3% of vaccinated patients were COVID infected after vaccination, and 88.2% were treated at home. Only 14.6% of the vaccinated population experienced a lupus flare, primarily after the first dose, with no significant difference between the type of vaccine and lupus flares. Conclusion: The acceptance of COVID-19 vaccination among our lupus patients was neutral. The observed adverse effects were comparable to those reported by healthy individuals. Post-vaccination lupus flares were infrequent and unrelated to the vaccine type but rather to the pre-vaccination disease activity state. Keywords: Lupus, COVID, Vaccine, Flare