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da Silva E Sousa FI, Silva RL, Filho CNRL, Santos MTOP, Martins LES, de Abreu TC, Nogueira LFA, Marques SC, de Souza MHLP, Braga LLBC. Vaccine adherence and adverse events of the SARS-COV vaccine in patients with inflammatory bowel disease. GASTROENTEROLOGIA Y HEPATOLOGIA 2024:S0210-5705(24)00160-2. [PMID: 38723765 DOI: 10.1016/j.gastrohep.2024.502202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 04/10/2024] [Accepted: 04/18/2024] [Indexed: 06/07/2024]
Abstract
OBJECTIVE To assess adherence to and the adverse effects of the SARS-COV vaccine in patients with inflammatory bowel disease (IBD). PATIENTS AND METHODS This is an observational, analytical, cross-sectional study. Sociodemographic and clinical data, SARS-COV vaccine data, medications for IBD with use during the vaccination period, and adverse events during the vaccination period were collected. Carried out logistic regressions with robust variance estimation to estimate the odds ratio with the respective 95% confidence intervals (95%CI) to assess the factors associated with non-serious adverse effects following vaccine doses as outcome variables. RESULTS 194 patients participated, with vaccine compliance of 78.3% for three doses of any vaccine (n=152). Local symptoms and mild systemic symptoms predominated, regardless of the type of vaccine. The first dose of the SARS-COV vaccine with AstraZeneca had a higher percentage of patients with vaccine symptoms. AstraZeneca vaccine increased the chance of non-serious adverse effects in IBD patients by 2.65 times (95% CI: 1.38-5.08; p=0.003), regardless of age, gender, physical activity, excess weight, use of disease-modifying drugs, immunobiological and corticosteroids. CoronaVac vaccine was associated with asymptomatic patients at the first dose and reduced the chance of adverse effects by 0.28 times (OR: 0.284; 95%CI: 0.13-0.62; p=0.002). CONCLUSION Local symptoms and mild systemic symptoms predominated, regardless of the type of vaccine. Using CoronaVac in the first dose reduced the chances of adverse effects, while AstraZeneca increased the risk of adverse effects.
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Affiliation(s)
| | - Raiza Lima Silva
- School of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil
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2
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Schell TL, Caldera F. A Practical Update on COVID-19 and Inflammatory Bowel Disease: COVID-19 Disease Risk and Vaccine Safety and Efficacy. Gastroenterol Hepatol (N Y) 2024; 20:88-97. [PMID: 38414911 PMCID: PMC10895915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
The COVID-19 pandemic introduced significant uncertainty regarding the care of patients with inflammatory bowel disease (IBD). Substantial research efforts have made progress in answering many of the questions that arose, but the constantly shifting paradigm of COVID-19-related research and recommendations has made it challenging for IBD clinicians to remain up-to-date. The goal of this article is to provide a concise and practical summary of the literature evaluating COVID-19 disease risk in addition to COVID-19 vaccine safety, immunogenicity, real-world effectiveness, and uptake among patients with IBD.
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Affiliation(s)
- Trevor L. Schell
- Department of Internal Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Freddy Caldera
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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3
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Casas Deza D, Julián Gomara AB, Caudevilla Biota E, Beltrán B, Domènech E, Gutiérrez Casbas A, Mañosa M, Zabana Y, Roc Alfaro L, Valverde Romero E, García González E, Sicilia B, Laredo V, Alcalá Escriche MJ, Madero Velázquez L, Ferreiro-Iglesias R, Palmero Pérez A, Calafat M, Rubio Iturria S, Moraleja Yudego I, Ber Nieto Y, García Mateo S, P Gisbert J, Vicente Lidón R, Arias L, Alfambra E, Doñate Borao AB, Peña González E, Corsino Roche P, Vicuña Arregui M, Elorza A, Domínguez Cajal M, Chaparro M, Barreiro-de Acosta M, García-López S. A booster dose of SARS-COV-2 vaccine improves suboptimal seroconversion rates in patients with inflammatory bowel disease. Results of a prospective multicenter study of GETECCU (VACOVEII study). GASTROENTEROLOGIA Y HEPATOLOGIA 2023:S0210-5705(23)00474-0. [PMID: 38007154 DOI: 10.1016/j.gastrohep.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 11/13/2023] [Accepted: 11/17/2023] [Indexed: 11/27/2023]
Abstract
BACKGROUND The response to SARS-CoV-2 vaccination decreases in inflammatory bowel disease (IBD) patients, specially under anti-TNF treatment. However, data on medium-term effectiveness are limited, specially using new recommended seroconversion rate (>260BAU/mL). Our aim was to evaluate the 6-month>260 BAU-seroconversion rate after full vaccination and after booster-dose. METHODS VACOVEII is a Spanish multicenter, prospective study promoted by GETECCU. IBD patients full vaccinated against SARS-CoV-2 and without previous COVID-19 infection, treated or not with immunosuppressants, were included. The booster dose was administered 6 months after the full vaccination. Seroconversion was set at 260BAU/mL, according to most recent recommendations and was assessed 6 months after the full vaccination and 6 months after booster-dose. RESULTS Between October 2021 and March 2022, 313 patients were included (124 no treatment or mesalazine; 55 immunomodulators; 87 anti-TNF; 19 anti-integrin; and 28 ustekinumab). Most patients received mRNA-vaccines (86%). Six months after full vaccination, overall seroconversion rate was 44.1%, being significantly lower among patients on anti-TNF (19.5%, p<0.001) and ustekinumab (35.7%, p=0.031). The seroconversion rate after booster was 92%. Again, anti-TNF patients had a significantly lower seroconversion rate (67%, p<0.001). mRNA-vaccine improved seroconversion rate (OR 11.720 [95% CI 2.26-60.512]). CONCLUSION The full vaccination regimen achieves suboptimal response in IBD patients, specially among those anti-TNF or ustekinumab. The booster dose improves seroconversion rate in all patients, although it remains limited in those treated with anti-TNF. These results reinforce the need to prioritize future booster doses in patients on immunosuppressants therapy, specially under anti-TNF, and using mRNA-vaccines.
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Affiliation(s)
- Diego Casas Deza
- Servicio de Aparato Digestivo, Hospital Universitario Miguel Servet de Zaragoza, Spain; Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Spain.
| | | | | | - Belén Beltrán
- Servicio de Aparato Digestivo, Hospital Universitari i Politècnic La Fe de Valencia, Spain
| | - Eugeni Domènech
- Servicio de Aparato Digestivo, Hospital Universitari Germans Trias i Pujol de Badalona, Universitat Autónoma de Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Spain
| | - Ana Gutiérrez Casbas
- Servicio de Aparato Digestivo, Hospital General Universitario Doctor Balmis de Alicante, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Spain; Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Spain
| | - Miriam Mañosa
- Servicio de Aparato Digestivo, Hospital Universitari Germans Trias i Pujol de Badalona, Universitat Autónoma de Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Spain
| | - Yamile Zabana
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Spain; Servicio de Aparato Digestivo, Hospital Universitari Mútua Terrassa, Spain
| | - Lourdes Roc Alfaro
- Servicio de Microbiología, Hospital Universitario Miguel Servet de Zaragoza, Spain
| | | | | | - Beatriz Sicilia
- Servicio de Aparato Digestivo, Hospital Universitario de Burgos, Spain
| | - Viviana Laredo
- Servicio de Aparato Digestivo, Hospital Clínico Lozano Blesa de Zaragoza, Spain
| | | | - Lucia Madero Velázquez
- Servicio de Aparato Digestivo, Hospital General Universitario Doctor Balmis de Alicante, Spain
| | - Rocío Ferreiro-Iglesias
- Servicio de Aparato Digestivo, Hospital Clínico Universitario de Santiago de Compostela, Instituto de Investigación Sanitaria Santiago de Compostela (IDIS), Spain
| | | | - Margalida Calafat
- Servicio de Aparato Digestivo, Hospital Universitari Germans Trias i Pujol de Badalona, Universitat Autónoma de Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Spain
| | | | | | | | - Sandra García Mateo
- Servicio de Aparato Digestivo, Hospital Clínico Lozano Blesa de Zaragoza, Spain
| | - Javier P Gisbert
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Spain; Servicio de Aparato Digestivo, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Universidad Autónoma de Madrid (UAM), Spain
| | - Raquel Vicente Lidón
- Servicio de Aparato Digestivo, Hospital Universitario Miguel Servet de Zaragoza, Spain
| | - Lara Arias
- Servicio de Aparato Digestivo, Hospital Universitario de Burgos, Spain
| | - Erika Alfambra
- Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Spain; Servicio de Aparato Digestivo, Hospital Clínico Lozano Blesa de Zaragoza, Spain
| | | | | | - Pilar Corsino Roche
- Servicio de Aparato Digestivo, Hospital Universitario Miguel Servet de Zaragoza, Spain; Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Spain
| | | | - Ainara Elorza
- Servicio de Aparato Digestivo, Hospital Universitario de Galdakao, Spain
| | | | - María Chaparro
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Spain; Servicio de Aparato Digestivo, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Universidad Autónoma de Madrid (UAM), Spain
| | - Manuel Barreiro-de Acosta
- Servicio de Aparato Digestivo, Hospital Clínico Universitario de Santiago de Compostela, Instituto de Investigación Sanitaria Santiago de Compostela (IDIS), Spain
| | - Santiago García-López
- Servicio de Aparato Digestivo, Hospital Universitario Miguel Servet de Zaragoza, Spain; Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Spain
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Wong SY, Wellens J, Helmus D, Marlow L, Brann S, Martinez Pazos V, Weinberg A, Moran HR, McGregor C, Vermeire S, Watanabe K, Kamikozuru K, Ahuja V, Vermani S, Lindsay JO, Kingston A, Dutta U, Kaur H, Silverberg MS, Milgrom R, Chien Ng S, Mak JWY, Cadwell K, Thompson C, Colombel JF, Satsangi J. Geography Influences Susceptibility to SARS-CoV-2 Serological Response in Patients With Inflammatory Bowel Disease: Multinational Analysis From the ICARUS-IBD Consortium. Inflamm Bowel Dis 2023; 29:1693-1705. [PMID: 37354560 DOI: 10.1093/ibd/izad097] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Indexed: 06/26/2023]
Abstract
BACKGROUND Beyond systematic reviews and meta-analyses, there have been no direct studies of serological response to COVID-19 in patients with inflammatory bowel disease (IBD) across continents. In particular, there has been limited data from Asia, with no data reported from India. The ICARUS-IBD (International study of COVID-19 Antibody Response Under Sustained immunosuppression in IBD) consortium assessed serological response to SARS-CoV-2 in patients with IBD in North America, Europe, and Asia. METHODS The ICARUS-IBD study is a multicenter observational cohort study spanning sites in 7 countries. We report seroprevalence data from 2303 patients with IBD before COVID-19 vaccination between May 2020 and November 2021. SARS-CoV-2 anti-spike and anti-nucleocapsid antibodies were analyzed. RESULTS The highest and lowest SARS-CoV-2 anti-spike seropositivity rates were found in Asia (81.2% in Chandigarh and 57.9% in Delhi, India; and 0% in Hong Kong). By multivariable analysis, country (India: odds ratio [OR], 18.01; 95% confidence interval [CI], 12.03-26.95; P < .0001; United Kingdom: OR, 2.43; 95% CI, 1.58-3.72; P < .0001; United States: OR, 2.21; 95% CI, 1.27-3.85; P = .005), male sex (OR, 1.46; 95% CI, 1.07-1.99; P = .016), and diabetes (OR, 2.37; 95% CI, 1.04-5.46; P = .039) conferred higher seropositivity rates. Biological therapies associated with lower seroprevalence (OR, 0.22; 95% CI, 0.15-0.33; P < .0001). Multiple linear regression showed associations between anti-spike and anti-nucleocapsid titers with medications (P < .0001) but not with country (P = .3841). CONCLUSIONS While the effects of medications on anti-SARS-CoV-2 antibody titers in patients with IBD were consistent across sites, geographical location conferred the highest risk of susceptibility to serologically detectable SARS-CoV-2 infection. Over half of IBD patients in India were seropositive prior to vaccination. These insights can help to inform shielding advice, therapeutic choices, and vaccine strategies in IBD patients for COVID-19 and future viral challenges.
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Affiliation(s)
- Serre-Yu Wong
- Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Judith Wellens
- Department of Gastroenterology and Hepatology, Leuven University Hospitals, Leuven, Belgium
| | - Drew Helmus
- Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Luke Marlow
- Translational Gastroenterology Unit, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Stephanie Brann
- Translational Gastroenterology Unit, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Vicky Martinez Pazos
- Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Alan Weinberg
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Hunter R Moran
- Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Colleen McGregor
- Translational Gastroenterology Unit, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Séverine Vermeire
- Department of Gastroenterology and Hepatology, Leuven University Hospitals, Leuven, Belgium
| | - Kenji Watanabe
- Center for Inflammatory Bowel Disease, Division of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan
| | - Koji Kamikozuru
- Center for Inflammatory Bowel Disease, Division of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan
| | - Vineet Ahuja
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Shubi Vermani
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - James O Lindsay
- Center for Immunobiology, Blizard Institute, Queen Mary University of London - Barts Health NHS Trust, London, United Kingdom
| | - Ashley Kingston
- Center for Immunobiology, Blizard Institute, Queen Mary University of London - Barts Health NHS Trust, London, United Kingdom
| | - Usha Dutta
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Harmandeep Kaur
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Mark S Silverberg
- Division of Gastroenterology, Department of Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Raquel Milgrom
- Division of Gastroenterology, Department of Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Siew Chien Ng
- Division of Gastroenterology and Hepatology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Joyce Wing Yan Mak
- Division of Gastroenterology and Hepatology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Ken Cadwell
- Division of Gastroenterology and Hepatology, Department of Medicine, Perelman School of Medicine of the University of Pennsylvania, Pennsylvania, PA, USA
- Department of Systems Pharmacology and Translational Therapeutics, Perelman School of Medicine of the University of Pennsylvania, Pennsylvania, PA, USA
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine of the University of Pennsylvania, Pennsylvania, PA, USA
| | - Craig Thompson
- Division of Biomedical Sciences, Warwick Medical School, University of Warwick, Warwick, United Kingdom
| | - Jean-Frédéric Colombel
- Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jack Satsangi
- Translational Gastroenterology Unit, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
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5
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Bianchi FP, Donghia R, Tatoli R, Bonfiglio C. COVID-19 Immunization Rates in Patients with Inflammatory Bowel Disease Worldwide: A Systematic Review and Meta-Analysis. Vaccines (Basel) 2023; 11:1523. [PMID: 37896927 PMCID: PMC10611173 DOI: 10.3390/vaccines11101523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 09/19/2023] [Accepted: 09/22/2023] [Indexed: 10/29/2023] Open
Abstract
Individuals with Inflammatory Bowel Disease (IBD) are characterized by an increased vulnerability to complications stemming from infectious diseases. While these patients do not inherently face a heightened risk of SARS-CoV-2 infection compared to the general population, their vulnerability to severe COVID-19 complications and subsequent hospitalization is notably increased. The objective of our study is to quantitatively assess the global coverage of COVID-19 vaccination among individuals with IBD, achieved through a comprehensive meta-analysis and systematic review. Thirteen studies were systematically selected from scientific articles available in the MEDLINE/PubMed, ISI Web of Knowledge, and Scopus databases, spanning from 1 January 2021 to 25 July 2023. The pooled prevalence of COVID-19 vaccine uptake was estimated at 72% (95%CI = 59-83%) for at least one dose, 81% (95%CI = 68-91%) for the complete vaccination regimen, and 71% (95%CI = 46-91%) for the third dose. Analysis of the determinants influencing vaccination uptake revealed several significant associations. These encompassed Caucasian ethnicity, female sex, absence of immunosuppressive therapy, advanced age, prior receipt of the anti-influenza vaccine, absence of a history of COVID-19 infection, and the provision of advice from gastroenterologists, all linked to improved compliance. Our study underscores a noteworthy yet not entirely optimal COVID-19 vaccination coverage among individuals with IBD. A multifaceted approach is warranted to enhance vaccination rates. Within this context, the role of gastroenterologists extends beyond direct patient care, encompassing a pivotal responsibility in preventing complications stemming from post-infectious diseases.
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Affiliation(s)
| | - Rossella Donghia
- National Institute of Gastroenterology, IRCCS S. De Bellis, Research Hospital, 70013 Castellana Grotte, Italy; (R.D.); (R.T.); (C.B.)
| | - Rossella Tatoli
- National Institute of Gastroenterology, IRCCS S. De Bellis, Research Hospital, 70013 Castellana Grotte, Italy; (R.D.); (R.T.); (C.B.)
| | - Caterina Bonfiglio
- National Institute of Gastroenterology, IRCCS S. De Bellis, Research Hospital, 70013 Castellana Grotte, Italy; (R.D.); (R.T.); (C.B.)
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6
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Alexander JL, Liu Z, Muñoz Sandoval D, Reynolds C, Ibraheim H, Anandabaskaran S, Saifuddin A, Castro Seoane R, Anand N, Nice R, Bewshea C, D'Mello A, Constable L, Jones GR, Balarajah S, Fiorentino F, Sebastian S, Irving PM, Hicks LC, Williams HRT, Kent AJ, Linger R, Parkes M, Kok K, Patel KV, Teare JP, Altmann DM, Goodhand JR, Hart AL, Lees CW, Boyton RJ, Kennedy NA, Ahmad T, Powell N. COVID-19 vaccine-induced antibody and T-cell responses in immunosuppressed patients with inflammatory bowel disease after the third vaccine dose (VIP): a multicentre, prospective, case-control study. Lancet Gastroenterol Hepatol 2022; 7:1005-1015. [PMID: 36088954 PMCID: PMC9458592 DOI: 10.1016/s2468-1253(22)00274-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 08/15/2022] [Accepted: 08/16/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND COVID-19 vaccine-induced antibody responses are reduced in patients with inflammatory bowel disease (IBD) taking anti-TNF or tofacitinib after two vaccine doses. We sought to assess whether immunosuppressive treatments were associated with reduced antibody and T-cell responses in patients with IBD after a third vaccine dose. METHODS VIP was a multicentre, prospective, case-control study done in nine centres in the UK. We recruited immunosuppressed patients with IBD and non-immunosuppressed healthy individuals. All participants were aged 18 years or older. The healthy control group had no diagnosis of IBD and no current treatment with systemic immunosuppressive therapy for any other indication. The immunosuppressed patients with IBD had an established diagnosis of Crohn's disease, ulcerative colitis, or unclassified IBD using standard definitions of IBD, and were receiving established treatment with one of six immunosuppressive regimens for at least 12 weeks at the time of first dose of SARS-CoV-2 vaccination. All participants had to have received three doses of an approved COVID-19 vaccine. SARS-CoV-2 spike antibody binding and T-cell responses were measured in all participant groups. The primary outcome was anti-SARS-CoV-2 spike (S1 receptor binding domain [RBD]) antibody concentration 28-49 days after the third vaccine dose, adjusted by age, homologous versus heterologous vaccine schedule, and previous SARS-CoV-2 infection. The primary outcome was assessed in all participants with available data. FINDINGS Between Oct 18, 2021, and March 29, 2022, 352 participants were included in the study (thiopurine n=65, infliximab n=46, thiopurine plus infliximab combination therapy n=49, ustekinumab n=44, vedolizumab n=50, tofacitinib n=26, and healthy controls n=72). Geometric mean anti-SARS-CoV-2 S1 RBD antibody concentrations increased in all groups following a third vaccine dose, but were significantly lower in patients treated with infliximab (2736·8 U/mL [geometric SD 4·3]; p<0·0001), infliximab plus thiopurine (1818·3 U/mL [6·7]; p<0·0001), and tofacitinib (8071·5 U/mL [3·1]; p=0·0018) compared with the healthy control group (16 774·2 U/mL [2·6]). There were no significant differences in anti-SARS-CoV-2 S1 RBD antibody concentrations between the healthy control group and patients treated with thiopurine (12 019·7 U/mL [2·2]; p=0·099), ustekinumab (11 089·3 U/mL [2·8]; p=0·060), or vedolizumab (13 564·9 U/mL [2·4]; p=0·27). In multivariable modelling, lower anti-SARS-CoV-2 S1 RBD antibody concentrations were independently associated with infliximab (geometric mean ratio 0·15 [95% CI 0·11-0·21]; p<0·0001), tofacitinib (0·52 [CI 0·31-0·87]; p=0·012), and thiopurine (0·69 [0·51-0·95]; p=0·021), but not with ustekinumab (0·64 [0·39-1·06]; p=0·083), or vedolizumab (0·84 [0·54-1·30]; p=0·43). Previous SARS-CoV-2 infection (1·58 [1·22-2·05]; p=0·0006) was independently associated with higher anti-SARS-CoV-2 S1 RBD antibody concentrations and older age (0·88 [0·80-0·97]; p=0·0073) was independently associated with lower anti-SARS-CoV-2 S1 RBD antibody concentrations. Antigen-specific T-cell responses were similar in all groups, except for recipients of tofacitinib without evidence of previous infection, where T-cell responses were significantly reduced relative to healthy controls (p=0·021). INTERPRETATION A third dose of COVID-19 vaccine induced a boost in antibody binding in immunosuppressed patients with IBD, but these responses were reduced in patients taking infliximab, infliximab plus thiopurine, and tofacitinib. Tofacitinib was also associated with reduced T-cell responses. These findings support continued prioritisation of immunosuppressed groups for further vaccine booster dosing, particularly patients on anti-TNF and JAK inhibitors. FUNDING Pfizer.
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Affiliation(s)
- James L Alexander
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK; Department of Gastroenterology, Imperial College Healthcare NHS Trust, London, UK
| | - Zhigang Liu
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | | | | | - Hajir Ibraheim
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK; Department of Gastroenterology, Imperial College Healthcare NHS Trust, London, UK
| | - Sulak Anandabaskaran
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK; Department of Gastroenterology, St Mark's Hospital and Academic Institute, London, UK
| | - Aamir Saifuddin
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK; Department of Gastroenterology, St Mark's Hospital and Academic Institute, London, UK
| | - Rocio Castro Seoane
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Nikhil Anand
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Rachel Nice
- Exeter Inflammatory Bowel Disease and Pharmacogenetics Research Group, University of Exeter, Exeter, UK; Department of Clinical Chemistry, Biochemistry, Exeter Clinical Laboratory International, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Claire Bewshea
- Exeter Inflammatory Bowel Disease and Pharmacogenetics Research Group, University of Exeter, Exeter, UK
| | - Andrea D'Mello
- Division of Medicine and Integrated Care, Imperial College Healthcare NHS Trust, London, UK
| | - Laura Constable
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Gareth R Jones
- Department of Gastroenterology, Western General Hospital, NHS Lothian, Edinburgh, UK; Centre for Inflammation Research, The Queen's Medical Research Institute, The University of Edinburgh, Edinburgh, UK
| | - Sharmili Balarajah
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK; Department of Gastroenterology, Imperial College Healthcare NHS Trust, London, UK
| | - Francesca Fiorentino
- Department of Surgery and Cancer, Imperial College London, London, UK; Nightingale-Saunders Clinical Trials and Epidemiology Unit, King's Clinical Trials Unit, King's College London, London, UK
| | - Shaji Sebastian
- Department of Gastroenterology, Hull University Teaching Hospitals NHS Trust, Hull, UK; Hull York Medical School, University of Hull, Hull, UK
| | - Peter M Irving
- School of Immunology and Microbial Sciences, King's College London, London, UK; Department of Gastroenterology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Lucy C Hicks
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK; Department of Gastroenterology, Imperial College Healthcare NHS Trust, London, UK
| | - Horace R T Williams
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK; Department of Gastroenterology, Imperial College Healthcare NHS Trust, London, UK
| | - Alexandra J Kent
- Department of Gastroenterology, King's College Hospital, London, UK
| | - Rachel Linger
- The NIHR Bioresource, University of Cambridge, Cambridge, UK
| | - Miles Parkes
- The NIHR Bioresource, University of Cambridge, Cambridge, UK; Department of Gastroenterology, Cambridge University Hospitals NHS Trust, Cambridge, UK
| | - Klaartje Kok
- Department of Gastroenterology, Bart's Health NHS Trust, London, UK
| | - Kamal V Patel
- Department of Gastroenterology, St George's Hospital NHS Trust, London, UK
| | - Julian P Teare
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK; Department of Gastroenterology, Imperial College Healthcare NHS Trust, London, UK
| | - Daniel M Altmann
- Department of Immunology and Inflammation, Imperial College London, London, UK
| | - James R Goodhand
- Exeter Inflammatory Bowel Disease and Pharmacogenetics Research Group, University of Exeter, Exeter, UK; Department of Gastroenterology, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Ailsa L Hart
- Department of Gastroenterology, St Mark's Hospital and Academic Institute, London, UK
| | - Charlie W Lees
- Department of Gastroenterology, Western General Hospital, NHS Lothian, Edinburgh, UK; Centre for Inflammation Research, The Queen's Medical Research Institute, The University of Edinburgh, Edinburgh, UK
| | - Rosemary J Boyton
- Department of Infectious Disease, Imperial College London, London, UK; Lung Division, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Nicholas A Kennedy
- Exeter Inflammatory Bowel Disease and Pharmacogenetics Research Group, University of Exeter, Exeter, UK; Department of Gastroenterology, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Tariq Ahmad
- Exeter Inflammatory Bowel Disease and Pharmacogenetics Research Group, University of Exeter, Exeter, UK; Department of Gastroenterology, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Nick Powell
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK; Department of Gastroenterology, Imperial College Healthcare NHS Trust, London, UK.
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