Crohn’s and Colitis Canada’s 2021 Impact of COVID-19 and Inflammatory Bowel Disease in Canada: COVID-19 Vaccines—Biology, Current Evidence and Recommendations

Abstract

The COVID-19 pandemic has ushered a globally focused vaccine development program that produced multiple successful vaccines within a year. Four SARS-CoV-2 vaccines have been approved for use in Canada, using two different technologies, all of which have shown excellent efficacy in reducing the rate of symptomatic COVID-19 infection and 100% efficacy in preventing death from COVID-19. People with inflammatory bowel disease (IBD), like many others with immune-mediated chronic diseases, were excluded from the pivotal trials of these vaccines, leading to early hesitancy by regulatory bodies to endorse administering the vaccines to these groups. However, recent data has shown that the adverse event rate to SARS-CoV-2 vaccine among people with IBD is similar to the general population. Early data has further shown that people with IBD are capable of mounting a robust immune response to SARS-CoV-2 vaccines, particularly following a second dose, whereas the response to the first dose is blunted in those receiving anti-TNF therapy or conventional immunosuppressants (azathioprine, 6-mercaptopurine, methotrexate). Based on these data and evidence from previous vaccine programs among people with IBD, multiple national and international expert panels have recommended that individuals with IBD receive complete vaccination against SARS-CoV-2 as soon as possible.

Serological Responses to the First Three Doses of SARS-CoV-2 Vaccination in Inflammatory Bowel Disease: A Prospective Cohort Study

“…A three-dose SARS-CoV-2 vaccination schedule for individuals with IBD has been proposed based on impaired serological responses to two-dose regimens. 12,21,22 Our study demonstrates near complete seroconversion to 3 rd dose vaccination with significantly higher antibody titres when compared to 2 nd dose vaccination. Third dose antibody responses are consistently high across all IBD therapies for maintenance of remission including biologic and immunomodulator therapies.…”

“…7 Consequently, gastroenterology organizations and public health officials have recommended three-dose vaccine regimens for individuals with IBD. 12 Despite recommendations, uptake of 3 rd dose vaccines remains low in the IBD population. 13…”

“…7 Consequently, gastroenterology organizations and public health officials have recommended three-dose vaccine regimens for individuals with IBD. 12 Despite recommendations, uptake of 3 rd dose vaccines remains low in the IBD population. 13 We examined the serological response following the 1 st , 2 nd , and 3 rd dose of SARS-CoV-2 vaccines in those with IBD; the decay of antibodies over time; and the factors, including medications, associated with antibody titres in those with IBD.…”

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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Editorial: COVID‐19 vaccines are safe and effective in patients with inflammatory bowel disease—but many unanswered questions remain

“…However, people who are immunocompromised were excluded from the initial randomised trials despite concerns that they were at increased risk of severe COVID‐19. This paradox and consequent lack of evidence resulted in recommendations for COVID‐19 vaccines for inflammatory bowel disease (IBD) patients that were extrapolated from other populations 1,3 . The scientific community moved quickly to address vaccine safety and effectiveness with prospective observational research and routinely collected health data.…”