Antibody Responses After SARS-CoV-2 mRNA Vaccination in Adults With Inflammatory Bowel Disease

Melmed, Gil Y.; Botwin, Greg; Sobhani, Kimia; Li, Dalin; Prostko, John; Figueiredo, Jane C.; Cheng, Susan; Braun, Jonathan; McGovern, Dermot P.

doi:10.7326/m21-2483

Cited by 60 publications

(80 citation statements)

References 5 publications

(7 reference statements)

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“…Median (IQR) SARS-CoV-2 IgG level was lower in patients treated with infliximab combination therapy (99 BAU/mL (40, 177)) than the healthy participants (139 BAU/mL (120, 188)) following vaccination with BNT162b2 (p = 0.0032). Median SARS-CoV-2-neutralizing antibodies were also lower in the study group compared with the control group (64 (23,94) vs. 91 (85, 94), p < 0.001). The median IgA level in the study group was also significantly lower when compared with the control group (6 U/mL (3, 34) vs. 13 U/mL (7,30), p = 0.0097) (see Table 2).…”

Section: Discussionmentioning

confidence: 79%

“…They concluded infliximab is associated with lower seropositivity to a single dose of BNT162b2 or mRNA-1273 vaccines in patients with IBD. On the other hand, one study [23] assessed antibody titers in adults with IBD who received mRNA SARS-CoV-2 vaccination and were referred from 18 U.S. gastroenterology practices. Participants were receiving various medication regimens including anti-integrin therapy, anti-interleukin-12/23 therapy, and anti-tumor necrosis factor with or without immunomodulator.…”

Section: Discussionmentioning

confidence: 99%

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Immunogenicity of BNT162b2 Vaccine in Patients with Inflammatory Bowel Disease on Infliximab Combination Therapy: A Multicenter Prospective Study

Shehab

Abu‐Farha

Alrashed

et al. 2021

JCM

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Background: Vaccination is a promising strategy to protect vulnerable groups like inflammatory bowel disease (IBD) patients against COVID-19 and associated severe outcomes. COVID-19 vaccine clinical trials excluded IBD patients taking infliximab with azathioprine or 6-mercaptopurine (infliximab combination). Therefore, we sought to evaluate serologic responses to COVID-19 vaccination with the mRNA vaccine, BNT162b2, in patients with IBD receiving infliximab combination therapy compared with healthy participants. Method: This was a multicenter prospective study. Patients with IBD were recruited at the time of attendance at infusion center between 1 August 2021, and 15 September 2021. Our primary outcome were the concentrations of SARS-CoV-2 antibodies 4–10 weeks after vaccination with two doses of BNT162b2 vaccine in patients with IBD taking infliximab combination therapy (study group) compared with a healthy participants group (control group). Both study and control groups were matched for age, sex, and time-since-last-vaccine-dose using optimal pair-matching method. Results: In total, 116 participants were recruited in the study, 58 patients in the study group and 58 in the control group. Median (IQR) IgG concentrations were lower in the study group (99 BAU/mL (40, 177)) than the control group (139 BAU/mL (120, 188)) following vaccination (p = 0.0032). Neutralizing antibodies were also lower in the study group compared with the control group (64% (23, 94) vs. 91% (85, 94), p < 0.001). The median IgA levels in the study group were also significantly lower when compared with the control group (6 U/mL (3, 34) vs. 13 U/mL (7, 30), p = 0.0097). In the study group, the percentages of patients who achieved positive IgG, neutralizing antibody and IgA levels were 81%, 75%, and 40%, respectively. In the control group, all participants (100%) had positive IgG and neutralizing antibody levels while 62% had positive IgA levels. Conclusion: In patients with IBD receiving infliximab combination therapy, SARS-CoV2 IgG, IgA, and neutralizing antibody levels after BNT162b2 vaccination were lower compared with healthy participants. However, most patients treated with infliximab combination therapy seroconverted after two doses of the vaccine.

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Section: Discussionmentioning

confidence: 79%

Section: Discussionmentioning

confidence: 99%

Immunogenicity of BNT162b2 Vaccine in Patients with Inflammatory Bowel Disease on Infliximab Combination Therapy: A Multicenter Prospective Study

Shehab

Abu‐Farha

Alrashed

et al. 2021

JCM

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“…Studies have since demonstrated a humoral immune response rate of 95-99% following vaccination with a two-dose mRNA vaccine series in patients with IBD. 1,2 Results show that those on certain immune-modifying therapies, such as anti-tumor necrosis factor (anti-TNF) therapy in combination with an immunomodulator or the use of systemic corticosteroids, exhibit a relatively diminished humoral immune response and a relative decrease in serum antibody concentrations over time. [1][2][3] For those who are moderately-to-severely immunocompromised, the Advisory Committee on Immunization Practice (ACIP) recommends a three-dose primary mRNA vaccine series.…”

Section: Introductionmentioning

confidence: 99%

“…1,2 Results show that those on certain immune-modifying therapies, such as anti-tumor necrosis factor (anti-TNF) therapy in combination with an immunomodulator or the use of systemic corticosteroids, exhibit a relatively diminished humoral immune response and a relative decrease in serum antibody concentrations over time. [1][2][3] For those who are moderately-to-severely immunocompromised, the Advisory Committee on Immunization Practice (ACIP) recommends a three-dose primary mRNA vaccine series. The aim of this study was to evaluate the humoral immunogenicity of a third COVID-19 mRNA vaccine dose in patients with IBD.…”

Section: Introductionmentioning

confidence: 99%

“…Study , tofacitinib, or systemic corticosteroid therapy (i.e., any of the aforementioned groups plus systemic corticosteroid)1 Completed two-dose series and had serum antibody concentrations measured 28-35 days thereafter2 Completed third dose and had serum antibody concentrations measured 28-65 days thereafter Abbreviations: Inflammatory Bowel Disease (IBD), no. (number), interquartile range (IQR), tumor necrosis factor (TNF)…”

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confidence: 99%

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Humoral Immunogenicity of Three COVID-19 mRNA Vaccine Doses in Patients with Inflammatory Bowel Disease

Schell

Knutson

Saha

et al. 2021

Preprint

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Immunogenicity and Safety of Standard and Third‐Dose SARS–CoV‐2 Vaccination in Patients Receiving Immunosuppressive Therapy

Syversen

Jyssum

Tveter

et al. 2022

Arthritis & Rheumatology

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Objective Immunogenicity and safety following receipt of the standard SARS–CoV‐2 vaccination regimen in patients with immune‐mediated inflammatory diseases (IMIDs) are poorly characterized, and data after receipt of the third vaccine dose are lacking. The aim of the study was to evaluate serologic responses and adverse events following the standard 2‐dose regimen and a third dose of SARS–CoV‐2 vaccine in IMID patients receiving immunosuppressive therapy. Methods Adult patients receiving immunosuppressive therapy for rheumatoid arthritis, spondyloarthritis, psoriatic arthritis, Crohn's disease, or ulcerative colitis, as well as healthy adult controls, who received the standard 2‐dose SARS–CoV‐2 vaccination regimen were included in this prospective observational study. Analyses of antibodies to the receptor‐binding domain (RBD) of the SARS–CoV‐2 spike protein were performed prior to and 2–4 weeks after vaccination. Patients with a weak serologic response, defined as an IgG antibody titer of ≤100 arbitrary units per milliliter (AU/ml) against the receptor‐binding domain of the full‐length SARS–Cov‐2 spike protein, were allotted a third vaccine dose. Results A total of 1,505 patients (91%) and 1,096 healthy controls (98%) had a serologic response to the standard regimen (P < 0.001). Anti‐RBD antibody levels were lower in patients (median 619 AU/ml interquartile range [IQR] 192–4,191) than in controls (median 3,355 AU/ml [IQR 896–7,849]) (P < 0.001). The proportion of responders was lowest among patients receiving tumor necrosis factor inhibitor combination therapy, JAK inhibitors, or abatacept. Younger age and receipt of messenger RNA–1273 vaccine were predictors of serologic response. Of 153 patients who had a weak response to the standard regimen and received a third dose, 129 (84%) became responders. The vaccine safety profile among patients and controls was comparable. Conclusion IMID patients had an attenuated response to the standard vaccination regimen as compared to healthy controls. A third vaccine dose was safe and resulted in serologic response in most patients. These data facilitate identification of patient groups at risk of an attenuated vaccine response, and they support administering a third vaccine dose to IMID patients with a weak serologic response to the standard regimen.

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Antibody Responses After SARS-CoV-2 mRNA Vaccination in Adults With Inflammatory Bowel Disease

Cited by 60 publications

References 5 publications

Immunogenicity of BNT162b2 Vaccine in Patients with Inflammatory Bowel Disease on Infliximab Combination Therapy: A Multicenter Prospective Study

Immunogenicity of BNT162b2 Vaccine in Patients with Inflammatory Bowel Disease on Infliximab Combination Therapy: A Multicenter Prospective Study

Humoral Immunogenicity of Three COVID-19 mRNA Vaccine Doses in Patients with Inflammatory Bowel Disease

Immunogenicity and Safety of Standard and Third‐Dose SARS–CoV‐2 Vaccination in Patients Receiving Immunosuppressive Therapy

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