Protective SARS-CoV-2 Antibody Response in Children With Inflammatory Bowel Disease

Abstract

BackgroundTo date, there's no evidence of an increased risk of SARS-CoV-2 infection or more severe COVID-19 in patients with inflammatory bowel disease (IBD). However, whether COVID-19 alters the clinical course of IBD or whether IBD treatment affects the immunological response to SARS-CoV-2 is still under investigation, especially in children.AimTo assess the serological response to SARS-CoV-2 in children with IBD, and to evaluate the impact of COVID-19 on the clinical course of IBD.Material and MethodsThis prospective study enrolled children (0–18 years) followed-up at the University Hospital of Padova for IBD, who acquired a confirmed SARS-CoV-2 infection between 02.2020 and 02.2021. The anti-SARS-CoV-2 S-RBD IgG titer was evaluated at 3 months after infection and compared to that of a control group of healthy children matched for age, sex, and COVID-19 severity.ResultsTwelve children with IBD (M = 5; median age 14 years) contracted COVID-19 during the study period. 11/12 patients were under immunomodulatory treatment (4/12 steroids; 6/12 azathioprine; 3/12 anti-TNFs; 2 vedolizumab; 1 ustekinumab). SARS-CoV-2 infection remained asymptomatic in 4/12 children and caused mild COVID-19 in the remaining 8. Mean anti-SARS-CoV-2 IgG S-RBD titer was similar between IBD patients and controls (27.3 ± 43.8 vs. 36.8 ± 35.3 kAU/L, p = ns). No children experienced IBD flares nor required gastroenterological support during the infection period.DiscussionChildren with IBD can mount a protective humoral response against SARS-CoV-2, which is comparable to that of their healthy peers regardless of ongoing immunomodulatory treatment. This study also supports the favorable course of PIBD during COVID-19 and vice-versa.

Risks of SARS-CoV-2 Infection and Immune Response to COVID-19 Vaccines in Patients With Inflammatory Bowel Disease: Current Evidence

“…A lower severity of COVID-19 has been shown also by other authors (24,33,34). Allocca et al found that the case fatality rate was 0% in IBD patients and 13%-15% in the general population (24) (35). Four remained asymptomatic and 8 had only mild clinical manifestations.…”

“…A more recent study by Bosa et al. including 12 children aged 12-18 years (9 CD, 1 UC and 2 IBDU) among whom 11 were receiving immunosuppressive therapy revealed that the antibody response to SARS-CoV-2 infection was quite similar to that detected in 48 healthy children convalescent after COVID-19, matched for sex, age, time of SARS-CoV-2 infection and COVID-19 severity (27.3 ± 43.8 kAU/L vs 36.8 ± 35.3 kAU/L; p=0.451) ( 35 ). On the contrary, Dailey et al.…”

“…All the 7 symptomatic patients seroconverted whereas no antibody was identified in the serum of 2 out of 5 asymptomatic children. A more recent study by Bosa et (35). On the contrary, Dailey et al after evaluation of humoral response of 44 IBD patients aged 11-26 years (34 with CD and 10 with UC/ IBDU) who were receiving infliximab or vedolizumab alone or in combination with methotrexate concluded that humoral response of these patients approximately after 4 weeks after infection was significantly lower than that measured in otherwise healthy hospitalized pediatric patients of the same age with COVID-19 (35).…”

“…On the contrary, Dailey et al. after evaluation of humoral response of 44 IBD patients aged 11-26 years (34 with CD and 10 with UC/IBDU) who were receiving infliximab or vedolizumab alone or in combination with methotrexate concluded that humoral response of these patients approximately after 4 weeks after infection was significantly lower than that measured in otherwise healthy hospitalized pediatric patients of the same age with COVID-19 ( 35 ). No neutralizing activity was observed in 5 cases (11.4%).…”

“…None of the 12 children with IBD (median age 14 years) described by Bosa et al. had a severe COVID-19, despite 11 of them were receiving immunomodulatory treatment ( 35 ). Four remained asymptomatic and 8 had only mild clinical manifestations.…”