- Design
- Systematic review of 49 studies (observational studies, trials and pharmacovigilance reports)
- Population
- Adults with systemic autoimmune rheumatic diseases and other immunocompromised adults
- Primary outcome
- RSV epidemiology, vaccine effectiveness, immunogenicity and safety
- Effect
- First-season effectiveness 60 to 73% in immunocompromised adults; one study with rheumatic RSV outcomes
RSV vaccines are available for older adults, but people with systemic autoimmune rheumatic diseases, including those on immunosuppressants, were excluded from the trials. This systematic review of 49 studies asked what is known for them.
Only one study reported RSV outcomes in people with these diseases, and none looked at vaccine effectiveness by DMARD class. Observational data suggested autoimmune and immunocompromising conditions are linked to more RSV hospitalisation, though bias limits that conclusion. First-season effectiveness was 60 to 73% in immunocompromised adults, with protection that appeared weaker and to wane faster than in immunocompetent people. Immunogenicity studies showed reduced seroconversion on immunosuppression. No consistent autoimmune safety signal emerged, though data in these patients are limited.
The authors suggest vaccination be considered for eligible patients using a personalised framework until more evidence arrives. Eligibility and availability vary by country, and this review does not address India.
- Consider RSV vaccination for eligible older or high-risk patients on immunosuppression, on a case-by-case basis.
- Warn that protection may be weaker and wane sooner than in the general population.
- Check national eligibility and local availability before recommending it.
- Time vaccination around immunosuppression where feasible, since response may be reduced.
- Report any adverse events so safety data in this group accumulate.
Why it matters
A group at higher risk of severe RSV was left out of the vaccine trials, so clinicians are deciding without direct evidence.
Don't overread it
Only one included study reported RSV outcomes in these diseases; effectiveness figures are extrapolated from related populations.
The statistics, in plain English
A first-season effectiveness of 60 to 73% comes from immunocompromised adults in general, not from people with rheumatic diseases specifically. It estimates how much lower the risk of RSV illness was after vaccination compared with no vaccination.
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