Humoral Immunogenicity of mRNA COVID-19 Vaccines Among Patients With Inflammatory Bowel Disease and Healthy Controls

Abstract

INTRODUCTION: Patients with inflammatory bowel disease (IBD) on immune-modifying therapies may have a lower vaccine response to certain vaccines. The aim of our study was to evaluate humoral immunogenicity of mRNA coronavirus disease 2019 (COVID-19) vaccines among patients with IBD and healthy controls (HCs). METHODS: We performed a prospective study to evaluate humoral immunogenicity among patients with IBD and HCs after completion of mRNA COVID-19 vaccines. RESULTS: One hundred twenty-two patients with IBD and 60 HCs were enrolled. All HCs and 97% of patients with IBD developed antibodies. Antibody concentrations were lower in patients with IBD compared with those in HCs (median 31 vs 118 μg/mL; P < 0.001). Those who received the mRNA-1273 (Moderna) COVID-19 (median 38; interquartile range [IQR] 24–75 vs μg/mL) had higher antibody concentrations compared with those who received the Pfizer-BNT vaccine series (median 22; IQR 11–42 μg/mL; P < 0.001). Patients on immune-modifying therapy (median 26; IQR 13–50 μg/mL) had lower antibody concentrations compared with those who were on no treatment, aminosalicylates, or vedolizumab (median 59; IQR 31–75 μg/mL; P = 0.003). DISCUSSION: Almost all patients with IBD in our study mounted an antibody response. Future studies are needed in evaluating sustained humoral immunity and the impact of booster dosing in patients with IBD.

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

“…4,5 Furthermore, those who completed a three-dose Moderna series had higher antibody concentrations than those who completed a three-dose Pfizer series, which is similar to previously reported findings regarding the two-dose series. 2 There is evidence of waning humoral immunity in the general population following COVID-19 vaccination, especially in those who are immunosuppressed or older than 65 years. 6 We observed this phenomenon in our HC cohort, none of whom received a third dose.…”

“…IBD treatment groups were defined as subjects on stable doses of maintenance therapy as previously described. 2 Non-immunosuppressive therapy was defined as absence of IBD therapy, mesalamine monotherapy, or vedolizumab monotherapy. Immunosuppressive therapy was defined as thiopurine monotherapy (i.e., azathioprine, 6-mercaptopurine), anti-TNF monotherapy, anti-TNF combination therapy (i.e., plus antimetabolite), ustekinumab monotherapy or combination therapy, tofacitinib, or systemic corticosteroid therapy (i.e., any of the aforementioned groups plus systemic corticosteroids).…”

“…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.…”

“…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.…”

“…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)…”