What Gastroenterologists Should Know About COVID-19 Vaccines

Rolak, Stacey; Hayney, Mary S.; Farraye, Francis A.; Temte, Jonathan L.; Caldera, Freddy

doi:10.1016/j.cgh.2021.01.001

Cited by 11 publications

(9 citation statements)

References 10 publications

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“…21 These results underline the relevance of immunizing cirrhotic patients as proposed by interim recommendations. 22 In comparison to previous studies, 5,6 this study included different vaccination regimens, measured immune response in more detail, and also investigated pretransplant patients with decompensated cirrhosis.…”

Section: Discussionmentioning

confidence: 99%

SARS-CoV2-specific Humoral and T-cell Immune Response After Second Vaccination in Liver Cirrhosis and Transplant Patients

Ruether

Schaub

Duengelhoef

et al. 2022

Clinical Gastroenterology and Hepatology

122

209

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Background and Aims Detailed information on the immune response after second vaccination of cirrhotic patients and liver transplant (LT) recipients against SARS-CoV-2 is largely missing. We aimed at comparing the vaccine-induced humoral and T-cell responses of these vulnerable patient groups. Methods In this prospective cohort study, anti-SARS-CoV-2 spike-protein titers were determined using the DiaSorin LIAISON (anti-S Trimer) and Roche Elecsys (anti-S RBD) immunoassays in 194 patients (141 LT, 53 cirrhosis Child-Pugh A-C) and 56 healthy controls before and 10-84 days after second vaccination. The spike-specific T-cell response was assessed using an IFN-γ release assay (IGRA, EUROIMMUN). A logistic regression analysis was performed to identify predictors of low response. Results After the second vaccination, seroconversion was achieved in 63% of LT recipients and 100% of cirrhotic patients and controls using the anti-S Trimer assay. Median anti-SARS-CoV-2 titers of responding LT recipients were lower compared to cirrhotic patients and controls (p<0.001). Spike-specific T-cell response rates were 36.6%, 65.4%, and 100% in LT, cirrhosis, and controls, respectively. Altogether, 28% of LT recipients did neither develop a humoral nor a T-cell response after second vaccination. In LT recipients, significant predictors of absent or low humoral response were age >65y (OR: 4.57, 95%-CI 1.48-14.05) and arterial hypertension (OR: 2.50, 95%-CI 1.10-5.68), whereas vaccination failure was less likely with calcineurin inhibitor monotherapy than with other immunosuppressive regimens (OR: 0.36, 95%-CI 0.13-0.99). Conclusion Routine serological testing of the vaccination response and a third vaccination in patients with low or absent response seem advisable. These vulnerable cohorts need further research on the effects of heterologous vaccination and intermittent reduction of immunosuppression before booster vaccinations.

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Section: Discussionmentioning

confidence: 99%

SARS-CoV2-specific Humoral and T-cell Immune Response After Second Vaccination in Liver Cirrhosis and Transplant Patients

Ruether

Schaub

Duengelhoef

et al. 2022

Clinical Gastroenterology and Hepatology

122

209

View full text Add to dashboard Cite

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“…In response to the COVID-19 pandemic, international pharmaceutical companies have rapidly developed, tested and produced highly effective vaccines against the Severe Acute Respiratory Syndrome CoronaVirus 2 (SARS-CoV-2) virus. More than 200 COVID-19 vaccine candidates are under development or in clinical trials, using both traditional (inactivated or live attenuated vaccines) and newer (recombinant protein vaccines, vectored vaccines and RNA and DNA vaccines) technologies ( 1 , 2 ). Four vaccines having now been approved for use in Canada ( COVID-19 Vaccines: Authorized vaccines: Canada.ca ).…”

Section: Introductionmentioning

confidence: 99%

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

Murthy

Kuenzig

Windsor

et al. 2021

Journal of the Canadian Association of Gastroenterology

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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.

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“…The primary outcome was the CMIR to mRNA COVID-19 vaccines in patients with IBD. The secondary outcomes were a comparison of the (1) CMIR in patients with IBD and HC and (2) CMIR and humoral immune response in all participants. (See Supplementary Methods for full details of measurement of humoral immune response, CMIR to SARS-CoV2 spike protein, and statistical analysis).…”

Section: Methodsmentioning

confidence: 99%

“…Two mRNA coronavirus disease 2019 (COVID-19) vaccines, mRNA-1273 (Moderna) and BNT162b2 (Pfizer-BioNTech), are highly effective in the general population. (1) Several studies have demonstrated that the majority of patients with inflammatory bowel disease (IBD) (95-99%) are able to achieve a measurable antibody response after the two-dose mRNA vaccine primary series, and 100% have a measurable antibody response after three doses. (2-5) Those who were less likely to seroconvert were older in age, received the BNT162b2 vaccine, and be on combination therapy with an anti-tumor necrosis factor alpha (TNF)-alpha inhibitor and an immunomodulator.…”

Section: Introductionmentioning

confidence: 99%

Cell-Mediated Immune Response after COVID 19 Vaccination in Patients with Inflammatory Bowel Disease

Caldera

Farraye

Necela

et al. 2022

Preprint

Self Cite

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Introduction Most patients with IBD mount an antibody response to mRNA COVID-19 vaccines, but few studies have evaluated the cell mediated immune response (CMIR). Methods We performed a prospective study (HERCULES) to evaluate CMIR among patients with IBD and healthy controls (HC) after completion of the primary series of mRNA COVID-19 vaccines. Results One hundred 158 patients with IBD and 20 HC were enrolled. The majority (89%) of IBD patients developed a CMIR which was not different than HC (94%, p=0.6667). There was no significant difference (p=0.5488) in CMIR response between those not immunosuppressed (median 255 Spike T cells/million PBMC, IQR 146, 958) and immunosuppressed (median 377, IQR 123, 1440). There was also no correlation between antibody responses and CMIR (p=0.5215) Discussion Most patients with IBD achieved CMIR to a COVID-19 vaccine. Future studies are needed evaluating sustained CMIR and clinical outcomes.

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What Gastroenterologists Should Know About COVID-19 Vaccines

Cited by 11 publications

References 10 publications

SARS-CoV2-specific Humoral and T-cell Immune Response After Second Vaccination in Liver Cirrhosis and Transplant Patients

SARS-CoV2-specific Humoral and T-cell Immune Response After Second Vaccination in Liver Cirrhosis and Transplant Patients

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

Cell-Mediated Immune Response after COVID 19 Vaccination in Patients with Inflammatory Bowel Disease

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