Anti-SARS-CoV-2 Vaccination and Antibody Response in Patients With Inflammatory Bowel Disease on Immune-modifying Therapy: Prospective Single-Tertiary Study

Abstract

Background Patients with inflammatory bowel disease (IBD) on immune-modifying treatment could be at an increased risk for severe coronavirus disease 2019 (COVID-19); thus, data on the efficacy and safety of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) vaccines are essential. We conducted a prospective study of IBD patients vaccinated with BNT162b2, CX-024414, and ChAdOx1 nCoV-19 vaccines. The aim was to evaluate the rate and magnitude of seroconversion, assess the effect of different immune-modifying treatment modalities on the magnitude of anti-SARS-CoV-2 IgG antibody levels, and analyze the impact of anti-SARS-CoV-2 vaccination on the inflammatory biomarkers of IBD. Methods The study included 602 IBD patients and 168 immunocompetent health care workers serving as controls. Serum anti-SARS-CoV-2 IgG antibodies were measured by chemiluminescent microparticle immunoassay before the vaccination and 8 weeks after the vaccination. Results Of IBD patients, 82.2% were receiving biological treatment: most of them were treated with antitumor necrosis factor (TNF)-α inhibitors (48.5%), and just under half of them were treated with concomitant thiopurines or methotrexate, followed by vedolizumab (18.6%) and ustekinumab (15.1%). Only 8.1% of patients were on 5-aminosalicylates, and a minority (2.2%) were treatment-free. The postvaccine seropositivity rate among IBD patients and controls was 97.8% vs 100%. Median anti-SARS-CoV-2 IgG levels were lower among IBD recipients of ChAdOx1 nCoV-19 compared with 2 other vaccines (P < .0001) and control ChAdOx1 nCoV-19 recipients (P=.01). No correlation was found between serum trough levels and anti-SARS-CoV-2 IgG concentrations for any of the biological drugs used. The TNF-α inhibitors with concomitant immunosuppressive treatment but no other treatment modalities were associated with a lower postvaccination antibody response (P < .0001). When evaluating the laboratory activity of IBD by C-reactive protein and fecal calprotectin levels, no significant differences were found before the vaccination and 8 weeks after its completion. Conclusions Our findings warrant particular attention to the anti-SARS-CoV-2 vaccination of IBD patients treated with TNF-α inhibitors with concomitant immunomodulators and show the priority of mRNA vaccines in this specific group of patients.

Humoral Immune Response in IBD Patients Three and Six Months after Vaccination with the SARS-CoV-2 mRNA Vaccines mRNA-1273 and BNT162b2

“…Six months after the second vaccination, IBD patients on anti-TNF therapy (adalimumab, infliximab) also showed significantly lower sVNT levels. These results support the study by Kennedy et [22,39]. Taken together, our study revealed a reduced humoral response in both S-IgG levels and sVNT inhibition levels in IBD patients, especially in patients treated with anti-TNF agents.…”

“…These results support the study by Kennedy et al which demonstrated lower antibody levels in IBD patients receiving infliximab therapy 3–10 weeks after the first vaccination [ 21 ]. Wong et al and Cerna et al also demonstrated lower antibody levels in IBD patients on immunosuppressive therapy with anti-TNF therapy and vedolizumab [ 22 , 39 ]. Taken together, our study revealed a reduced humoral response in both S-IgG levels and sVNT inhibition levels in IBD patients, especially in patients treated with anti-TNF agents.…”

Effectiveness and safety of SARS‐CoV‐2 vaccine in Inflammatory Bowel Disease patients: a systematic review, meta‐analysis and meta‐regression

“…Thus, 21 studies were included in their entirety as shown in Table 1. These included 11 prospective studies, seven retrospective studies and three survey‐based studies 16–21,27–41 . The PRISMA Flow chart is shown in Figure 1.…”

“…These included 11 prospective studies, seven retrospective studies and three survey‐based studies. 16 , 17 , 18 , 19 , 20 , 21 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 The PRISMA Flow chart is shown in Figure 1 . The study details are shown in Table 1 .…”

Safety of SARS-CoV-2 vaccination in patients with inflammatory bowel disease: A systematic review and meta-analysis

“…The details of the included studies are illustrated in Table 1 [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] . The details of the excluded studies with the reason for exclusion is shown in Supplementary Table 2 [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] .

Figure 1 PRISMA flow chart depicting the study screening and selection of the systematic review

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