Growing attention of immunogenicity among patients with autoimmune diseases post-SARS-CoV-2 vaccination: meta-analysis and systematic reviews of the current studies

This study aimed to identify the optimal strategy for patients with autoimmune diseases by comparing the immunoreaction and effectiveness of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines between healthy individuals and patients. The PubMed, Embase, and Cochrane Library were searched for eligible studies on effectiveness and immunoreaction to SARS-CoV-2 vaccines in patients with autoimmune diseases published until October 07, 2022. The quality of each included study was evaluated by independent reviewers using National Institutes of Health study quality assessment tool, and the STATA 15.0 software was used for all statistical analyses. A total of 84 publications were included and analyzed in this meta-analysis, favoring healthy controls regarding serological response (risk ratio, RR=0.88, 95% CI (confidence interval): 0.86–0.91), antibody response (RR=0.90, 95%CI: 0.87–0.94), and incidence of seropositive immunoglobulin G (IgG) (RR=0.74, 95%CI: 0.69–0.80) than patients post-vaccination. Patients with autoimmune diseases developed lower IgG (standard mean difference, SMD=−0.64 95%CI: −0.84 to −0.43) and antibody titer level (SMD=−1.39, 95%CI: −2.30 to −0.49) than healthy individuals in AU/ml. Stratified analyses were conducted further according to various potential factors in full-text studies. Patients who are immunocompromised and received more vaccines demonstrated poorer humoral responses and seropositive incidence after SARS-CoV-2 vaccination than healthy individuals. Despite the lack of observable favor for patients with autoimmune diseases, the trend of effectiveness of SARS-CoV-2 vaccines is close to that for healthy populations. Patients who are immunocompromised should be provided a better SARS-CoV-2 vaccination schedule, considering various vaccine subtypes, dose(s), variants of concern, and immunoassays.