SARS-CoV-2 Vaccination in IBD: Past Lessons, Current Evidence, and Future Challenges

Abstract

Since the beginning of the pandemic, patients with inflammatory bowel diseases (IBD) have been considered at high-risk for infection and complications of COVID-19. However, IBD patients and patients taking immunosuppressive therapy were excluded from clinical phase III vaccine trials, complicating the assessment of effectiveness of these new vaccines. From past experience we know that adapted vaccination strategies may be appropriate in some IBD patients to optimize immunogenicity. We review current evidence on SARS-CoV-2 vaccination relevant to IBD patients, including immune responses from humoral to cellular, emerging data on new variants and off-label vaccination schemes. We also identify clinical and scientific knowledge gaps that can be translated into both large-scale population-based studies and targeted vaccine studies to describe the precise immune responses induced by SARS-CoV-2 vaccines in IBD patients. We strongly endorse the recommendation of vaccinating IBD patients to ensure maximal protection from COVID-19 both for the individual and the community.

Serologic Response to Messenger RNA Coronavirus Disease 2019 Vaccines in Inflammatory Bowel Disease Patients Receiving Biologic Therapies

“…3 A study showing attenuated antinucleocapsid responses to SARS-CoV-2 infection in IBD patients on infliximab and another study reporting poor antispike antibody responses in organ transplant patients after the first dose of messenger RNA vaccines have raised concern regarding vaccine responses in IBD patients. [4][5][6] Still, the impact of medications on COVID-19 vaccine efficacy in IBD patients is unknown, because patients with immunosuppressed states and/or treated with immunosuppressants were excluded from vaccine trials. To address this, we evaluated serologic responses to COVID-19 vaccination with the SARS-CoV-2 spike (S) messenger RNA BNT162b2 (Pfizer-BioNTech) and messenger RNA-1273 (National Institutes of Health [NIH]-Moderna) vaccines in IBD patients.…”

Impairment of CD4+ T and Memory B Cell Responses but Normal Memory CD8+T-Cell Activation on Crohn’s Disease after COVID-19 Vaccination: A Twin Case

“…However, there is limited information about how biological therapy with immunosuppressive medication will influence the immune response during COVID-19 vaccination of IBD patients [4,14]. Wellens et al (2021) showed that humoral and cellular immune response in IBD could be impaired after some vaccines…”

COVID‐19 in gastroenterology: Where are we now? Current evidence on the impact of COVID‐19 in gastroenterology

“…Despite these concerns, vaccine effectiveness seems to be the key concern, rather than safety. All the entities and experts recommend COVID‐19 vaccination for IBD patients, 151 , 152 , 153 , 154 , 155 including those who had anaphylaxis following biologic treatment. 151 …”