RSV Vaccination in Systemic Autoimmune Rheumatic Diseases: A Systematic Review.

Abstract

Respiratory syncytial virus (RSV) vaccination is available for older adults. Patients with systemic autoimmune rheumatic diseases (SARDs), including those receiving immunosuppressive therapies, were excluded from trials. Evidence to guide vaccination decisions is limited. We conducted a systematic review evaluating RSV epidemiology, vaccine effectiveness, immunogenicity, and safety in adults with SARDs. Databases were searched from inception to 28th January 2026. Observational studies, clinical trials, and pharmacovigilance reports were included. Evidence specific to disease-modifying antirheumatic drugs (DMARDs) was examined where available. Of the 249 unique records returned, 43 met the inclusion criteria. Six studies were identified in the supplementary search, yielding 49 studies in total. Only one study reported RSV outcomes in SARD patients. No study evaluated vaccine effectiveness stratified by DMARD-class. Observational data suggest autoimmune and immunocompromising conditions are associated with increased RSV-associated hospitalisation, although attribution is uncertain due to bias and data limitations. RSV vaccines demonstrated first-season effectiveness of 60-73% in immunocompromised adults, with evidence of attenuated and more rapidly waning protection compared with immunocompetent populations. Immunogenicity studies from RSV and other vaccine platforms indicate reduced seroconversion in immunosuppressed patients. No consistent autoimmune safety signals were identified, though data in SARD populations remain limited. RSV poses a relevant, though incompletely quantified, risk for SARD patients. Vaccination appears effective and safe in immunocompromised populations, but protection may wane more rapidly. The absence of DMARD-specific data represents an evidence gap. Until further evidence emerges, vaccination should be considered for eligible patients using a personalised framework.