- Design
- Systematic review
- Population
- 49 studies relevant to adults with systemic autoimmune rheumatic diseases
- Primary outcome
- RSV epidemiology, vaccine effectiveness, immunogenicity and safety
- Effect
- First-season effectiveness 60–73% in immunocompromised adults; faster waning; no DMARD-specific data
RSV vaccines are available for older adults, but trials excluded people with autoimmune rheumatic diseases on immunosuppression. This systematic review gathered 49 studies of RSV epidemiology, vaccine effectiveness, immunogenicity and safety relevant to that group.
Only one study reported RSV outcomes specifically in rheumatic disease, and none reported effectiveness by DMARD class. Observational data suggested autoimmune and immunocompromising conditions were associated with more RSV hospitalisation. In immunocompromised adults generally, first-season vaccine effectiveness was 60% to 73%, with weaker and faster-waning protection than in healthy people. No consistent autoimmune safety signal appeared.
The practical reading is to offer RSV vaccination to eligible older patients with rheumatic disease, timed where possible before intensifying immunosuppression, while recognising the evidence is indirect. Availability and cost in India limit use.
- Offer RSV vaccination to eligible older adults with rheumatic disease on immunosuppression.
- Where possible, vaccinate before starting rituximab or other B-cell-depleting therapy.
- Expect reduced and shorter protection in immunosuppressed patients.
- Keep influenza and pneumococcal vaccination up to date as the better-established priorities.
Why it matters
Patients most at risk from RSV were excluded from the vaccine trials, so decisions rest on indirect evidence.
Don't overread it
Effectiveness comes from immunocompromised adults in general, not patients with rheumatic disease on specific DMARDs.
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