{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,22]],"date-time":"2025-10-22T00:47:11Z","timestamp":1761094031173,"version":"build-2065373602"},"reference-count":39,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2025,10,21]],"date-time":"2025-10-21T00:00:00Z","timestamp":1761004800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"the Brazilian Ministry of Health, Department of Science and Technology"},{"name":"Funda\u00e7\u00e3o para o Desenvolvimento Cient\u00edfico e Tecnol\u00f3gico em Sa\u00fade"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Vaccines"],"abstract":"<jats:p>Background: To prospectively evaluate the safety and clinical impact of SARS-CoV-2 vaccines in patients with systemic lupus erythematosus (SLE). Methods: Subanalysis of the Brazilian multicenter observational study \u201cSafety, Effectiveness and Duration of Immunity after Vaccination against SARS-CoV-2 in Patients with Immune-Mediated Inflammatory Diseases (SAFER)\u201d, which included SLE patients vaccinated with CoronaVac, ChAdOx1, or BNT162b2. Patients with HIV infection, pregnant women, or those with immunosuppression not related to SLE were excluded. Safety data related to adverse events and underlying disease activity were assessed. Additionally, COVID-19 cases were monitored throughout the follow-up period. Results: The study included 373 patients with systemic lupus erythematosus (SLE), with a mean age of 36 years, the majority being women (89.8%). The most common adverse events after SARS-CoV-2 vaccination were injection site reactions and headache, observed both after the first and subsequent doses. The ChAdOx-1 vaccine was associated with a higher frequency of adverse events compared to CoronaVac. At baseline, 38.3% of patients were in remission, 32.8% had low disease activity, and 28.9% had moderate to high activity. Following CoronaVac vaccination, there was an increase in remission rates (from 34.6% to 51.1%) and a significant reduction in moderate to high activity (from 37.6% to 15.0%) after the first dose, with this reduction partially maintained after the second dose. In contrast, patients vaccinated with ChAdOx-1 showed an increase in moderate to high activity (from 14.5% to 38.2% after the first dose), a trend that persisted after the second dose. No statistically significant changes in disease activity were observed among those who received BNT162b2. During follow-up, 44 cases of COVID-19 were reported, all mild, with no deaths or need for intensive care unit admission. Conclusions: Vaccination against SARS-CoV-2 demonstrated a favorable safety profile in patients with SLE, with a low frequency of serious adverse events. While analysis of disease activity revealed variations across vaccine platforms, most notably an increased proportion of moderate to high disease activity among those receiving ChAdOx-1 compared with CoronaVac and BNT162b2, the overall occurrence of COVID-19 during follow-up was limited to mild cases, with no severe outcomes. These findings highlight that, despite potential risks of disease exacerbation, the clear protection against severe COVID-19 supports vaccination as a beneficial strategy for this immunocompromised population.<\/jats:p>","DOI":"10.3390\/vaccines13101074","type":"journal-article","created":{"date-parts":[[2025,10,21]],"date-time":"2025-10-21T14:17:35Z","timestamp":1761056255000},"page":"1074","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Impact of SARS-CoV-2 Vaccination on Disease Activity and Severity of COVID-19 Infection in Patients with Systemic Lupus Erythematosus: A Multicenter Cohort Study"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4316-0771","authenticated-orcid":false,"given":"Nat\u00e1lia Sarzi","family":"Sartori","sequence":"first","affiliation":[{"name":"Servi\u00e7o de Reumatologia, Hospital de Cl\u00ednicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre 90010-150, RS, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ketty Lysie Libardi Lira","family":"Machado","sequence":"additional","affiliation":[{"name":"Hospital Universit\u00e1rio Cassiano Ant\u00f4nio Moraes (HUCAM), Universidade Federal do Esp\u00edrito Santo (UFES), Vit\u00f3ria 29041-295, ES, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0609-4063","authenticated-orcid":false,"given":"Samira Tatiyama","family":"Miyamoto","sequence":"additional","affiliation":[{"name":"Hospital Universit\u00e1rio Cassiano Ant\u00f4nio Moraes (HUCAM), Universidade Federal do Esp\u00edrito Santo (UFES), Vit\u00f3ria 29041-295, ES, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Flavia Zon","family":"Pretti","sequence":"additional","affiliation":[{"name":"Hospital Universit\u00e1rio Cassiano Ant\u00f4nio Moraes (HUCAM), Universidade Federal do Esp\u00edrito Santo (UFES), Vit\u00f3ria 29041-295, ES, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2264-327X","authenticated-orcid":false,"given":"Maria da Penha Gomes","family":"Gouveia","sequence":"additional","affiliation":[{"name":"Hospital Universit\u00e1rio Cassiano Ant\u00f4nio Moraes (HUCAM), Universidade Federal do Esp\u00edrito Santo (UFES), Vit\u00f3ria 29041-295, ES, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2049-5368","authenticated-orcid":false,"given":"Yasmin Gurtler Pinheiro de","family":"Oliveira","sequence":"additional","affiliation":[{"name":"Hospital Universit\u00e1rio Cassiano Ant\u00f4nio Moraes (HUCAM), Universidade Federal do Esp\u00edrito Santo (UFES), Vit\u00f3ria 29041-295, ES, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vanezia Gon\u00e7alves","family":"da Silva","sequence":"additional","affiliation":[{"name":"Hospital Universit\u00e1rio Cassiano Ant\u00f4nio Moraes (HUCAM), Universidade Federal do Esp\u00edrito Santo (UFES), Vit\u00f3ria 29041-295, ES, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Filipe","family":"Fa\u00e9","sequence":"additional","affiliation":[{"name":"Hospital Universit\u00e1rio Cassiano Ant\u00f4nio Moraes (HUCAM), Universidade Federal do Esp\u00edrito Santo (UFES), Vit\u00f3ria 29041-295, ES, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5056-5523","authenticated-orcid":false,"given":"Ana Paula Neves","family":"Burian","sequence":"additional","affiliation":[{"name":"Centro de Refer\u00eancias para Imunobiol\u00f3gicos Especiais (CRIE) da Secretaria de Sa\u00fade do Estado do Esp\u00edrito Santo, Vit\u00f3ria 29041-295, ES, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2033-9557","authenticated-orcid":false,"given":"Karina Rosemarie 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Campos","family":"Peixoto","sequence":"additional","affiliation":[{"name":"Escola Paulista de Medicina (EPM), Universidade Federal de S\u00e3o Paulo (UNIFESP), S\u00e3o Paulo 04023-062, SP, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Priscila Dias Cardoso","family":"Ribeiro","sequence":"additional","affiliation":[{"name":"Escola Paulista de Medicina (EPM), Universidade Federal de S\u00e3o Paulo (UNIFESP), S\u00e3o Paulo 04023-062, SP, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8662-4786","authenticated-orcid":false,"given":"Vanessa de Oliveira","family":"Magalh\u00e3es","sequence":"additional","affiliation":[{"name":"Escola Paulista de Medicina (EPM), Universidade Federal de S\u00e3o Paulo (UNIFESP), S\u00e3o Paulo 04023-062, SP, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8876-3226","authenticated-orcid":false,"given":"Mariana 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