Background Four EMA-approved vaccines against SARS-CoV-2 are currently available. Data regarding antibody responses to initial vaccination regimens in patients with inflammatory bowel diseases (IBD) are limited. Methods We conducted a prospective, controlled, multicenter study in tertiary Greek IBD centers. Participating patients had completed the initial vaccination regimens (1 or 2 doses, depending on the type of COVID-19 vaccine) at least 2 weeks before study enrolment. Anti-S1 IgG antibody levels were measured. Demographic and adverse events data were collected. Results We tested 403 patients (Crohn’s disease, 58.9%; male, 53.4%; median age, 45 years) and 124 healthy controls (HCs). Following full vaccination, 98% of patients seroconverted, with mRNA vaccines inducing higher seroconversion rates than viral vector vaccines (P = .021). In total, IBD patients had lower anti-S1 levels than HCs (P < .001). In the multivariate analysis, viral vector vaccines (P < .001), longer time to antibody testing (P < .001), anti-TNFα treatment (P = .013), and age (P = .016) were independently associated with lower anti-S1 titers. Vedolizumab monotherapy was associated with higher antibody levels than anti-TNFα or anti-interleukin-12/IL-23 monotherapy (P = .023 and P = .032). All anti- SARS-CoV-2 vaccines were safe. Conclusions Patients with IBD have impaired antibody responses to anti-SARS-CoV-2 vaccination, particularly those receiving viral vector vaccines and those on anti-TNFα treatment. Older age also hampers antibody production after vaccination. For those low-response groups, administration of accelerated or prioritized booster vaccination may be considered.
We report a 19-year-old male with congenital, combined deficiency of immunoglobulin (Ig) E and 2/4 subclasses of IgG (G1, G3) and chronic diarrhea. He presented at six years of age with chronic recurrent diarrhea responsive to immunoglobulin treatment. Initially, it was considered of infectious origin. However, at the age of 14 years, ileocolonoscopy and magnetic resonance enterography (MRE) were performed, and they showed a mild, limited, non-specific, terminal ileitis with increased eosinophil count on histology. A diagnosis of possible eosinophilic gastroenteritis was made, and budesonide was administered with temporary relief. However, at the age of 19 years, repeat ileocolonoscopy showed multiple ulcers in the terminal ileum and aphthous ulcers in the cecum, and repeat MRE demonstrated extensive ileal involvement. Esophagogastroduodenoscopy demonstrated the involvement of the upper GI tract with aphthous ulcers. Subsequently, gastric, ileal, and colonic biopsies revealed Ziehl-Neelsen-negative, noncaseating granulomas. We hereby report the first case of IgE and selective IgG1 and IgG3 deficiency complicated with Crohn's disease-like extensive GI involvement.
Background Up to fifteen percent of inflammatory bowel disease (IBD) patients are diagnosed after the age of 60 years (elderly onset-EO). Additionally, due to the ageing of population and the increasing prevalence of IBD the number of elderly patients (>60) with an earlier diagnosis (adult onset-AO) is rapidly increasing. We aimed to compare disease characteristics and management between EO and AO elderly IBD patients. Methods Data of a prospective longitudinal registry of IBD patients followed in a tertiary center over a ten-year period (2012-2022) were analyzed. Consecutive IBD patients aged over 60 years at study entry were included. They were divided into two groups according to their age at diagnosis <60 (AO) and ≥ 60 (ΕΟ) years. The two groups were compared as for their demographic and clinical characteristics, their treatment and outcomes (disease related surgeries, development of malignancy, death). Results Out of 1104 patients recorded in the IBD registry, 325 were currently ≥ 60 years old (29%) and among them 267 had complete data and were included in the study (Table 1). ΕΟ had 100 (37%) and ΑΟ 167 (63%). Median age at diagnosis (IQR) was 47 years (37-53) for AO and 66 years (62-71) for EO (p<0.0001) whereas median disease duration was 23 (15-31) and 9 (5-14) years respectively (P<0.0001). Male gender (AO:61%, EO:68%) and ulcerative colitis (UC) (AO: 60%, EO: 53%) predominated in both groups. Family history of IBD and extraintestinal manifestations were lower in the EO than the AO group (p=0.02 and p=0.01 respectively). UC localization was most commonly proctitis and left sided in both groups. CD was most often ileal in EO patients when compared with AO (p=0.028) and inflammatory phenotype was more prevalent in both groups (ΑΟ:69% and ΕΟ:79% respectively). Immunomodulators were less frequently used in EO (17% vs 40.8%, p=0.0001) which was not the case for biologics (40.1% vs 32%, p=0.18) and prednisolone (21.5% vs 16%, p=0.27). During a median disease duration of 16 (8-25) years, comparable rates of IBD-related surgeries (12.5% ΑΟ vs 9% EO) and total malignancies (18.5% ΑΟ vs 14% ΕΟ) were observed but there were more deaths in the ΕΟ group (20% vs 8.3%; p=0.0063). Conclusion There are some distinct differences in demographic, clinical characteristics, treatment and mortality between EO and AO elderly IBD patients. The comparable rates of biologic use and IBD-related surgeries probably indicate that EO-IBD does not have a mild disease course. The clinical implication of these findings needs further validation.
Background The novel corona virus (SARS-CoV-2) outbreak was declared as a pandemic in March 2020; this prompted the need for rapid vaccine development. Currently four EMA approved vaccines exist but their efficacy and safety data on patients with Inflammatory Bowel diseases are limited. Methods Greek IBD patients, from 10 tertiary referral centres, who had completed the initial vaccination protocol with the available anti-COVID-19 vaccines at least two weeks before enrolment, were prospectively studied. Demographic and safety data were collected and blood samples were drawn for serum Anti-S1 IgG measurement [Euroimmun Anti-SARS-CoV-2 QuantiVac ELISA (IgG)]. Results In total 403 IBD patients (59% Crohn’s disease, median age 45 years, 53% male) and 124 healthy controls (HC) were included (Table 1). Antibody testing was conducted after a median of 31 (IQR, 23–46) days post-vaccination. Following a full vaccination regimen, 98% of IBD patients seroconverted (anti-S1 IgG≥11 RU/ml). Administration of mRNA vaccines resulted in higher seroconversion rates and higher antibody titers than viral vector ones (98.6% vs 93.6%, P=0.02 and 111.2 RU/ml vs 76 RU/ml, P<0.0001, respectively). In total, IBD patients had lower anti-S1 levels than HC (RU/ml 108 vs 133 RU/ml, P=0.00009). IBD patients without immunosuppression had higher antibody titers than immunocompromised patients (P=0.012). In univariable analysis, older age, longer time since vaccination, and treatment with corticosteroids, immunomodulators, anti-TNFα or combination therapy were associated with lower anti-S1 titers. In contrast, higher anti-S1 levels were detected in patients on vedolizumab monotherapy or non-immunosuppressive treatment. In multivariable analysis, only age, time since vaccination, and anti-TNFα therapy remained significant (P=0.011, P=0.002, and P=0.013 respectively). Treatment with vedolizumab monotherapy was associated with higher antibody levels than anti-TNFα or ustekinumab monotherapy (P=0.023 and P=0.032). Patients with prior COVID-19 infection showed numerically higher levels of Abs. All vaccines were safe in IBD patients. Conclusion Patients with IBD have high seroconversion rates to anti-SARS-CoV-2 vaccines, with mRNA vaccines being more efficacious. However, IBD patients have impaired response to vaccination comparing to HC. Lower antibody responses were observed in patients who received viral vector vaccines, in older patients, and in those on anti-TNFα treatment. It is important to consider booster vaccination in those low-response groups.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.