SARS-CoV-2 vaccination in inflammatory bowel disease (IBD) patients – does treatment for IBD negatively affect SARS-CoV-2 antibodies? A single-centre, prospective study

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Abstract

Introduction

Inflammatory bowel disease (IBD) patients use a wide variety of immunosuppressive drugs, including biologics, but their effect on SARS-CoV-2 vaccine antibody levels remains a mystery.

Aim

We analysed whether the drugs used in the treatment of IBD patients could affect the concentration of SARS-CoV-2 antibodies.

Material and methods

This is a prospective, single-centre evaluation of the persistence of SARS-CoV-2 antibodies after vaccination at various time points: every 2 months throughout the 6 ^th month after the first dose.

Results

We included a total of 346 vaccinated IBD patients in the study. A negative correlation between antibody level and time from full vaccination was confirmed for the following types of therapy: infliximab (rho = –0.32, p < 0.001), adalimumab (rho = –0.35, p = 0.025), and vedolizumab (rho = –0.50, p < 0.001). In the case of other, long-term drug administration, a negative correlation between antibody level and time from full vaccination was confirmed for mesalazine (rho = –0.35, p < 0.001), budesonide (rho = –0.58, p = 0.004), systemic glucocorticoids (rho = –0.58, p < 0.001), and azathioprine (rho = –0.44, p < 0.001).

Conclusions

Due to the immunosuppressive and biological treatment, IBD patients are exposed to a shorter persistence of SARS-CoV-2 antibodies and require booster doses. The role of gastroenterologists in educating patients about the need to continue SARS-CoV-2 vaccination remains crucial.

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Most cited references 36

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Antibody Persistence through 6 Months after the Second Dose of mRNA-1273 Vaccine for Covid-19

Nicole Doria-Rose, Mehul S. Suthar, Mat Makowski … (2021)

To the Editor: Interim results from a phase 3 trial of the Moderna mRNA-1273 severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine indicated 94% efficacy in preventing coronavirus disease 2019 (Covid-19). 1 The durability of protection is currently unknown. We describe mRNA1273-elicited binding and neutralizing antibodies in 33 healthy adult participants in an ongoing phase 1 trial, 2-4 stratified according to age, at 180 days after the second dose of 100 μg (day 209). Antibody activity remained high in all age groups at day 209. Binding antibodies, measured by means of an enzyme-linked immunosorbent assay against SARS-CoV-2 spike receptor–binding domain, 2 had geometric mean end-point titers (GMTs) of 92,451 (95% confidence interval [CI], 57,148 to 149,562) in participants 18 to 55 years of age, 62,424 (95% CI, 36,765 to 105,990) in those 56 to 70 years of age, and 49,373 (95% CI, 25,171 to 96,849) in those 71 years of age or older. Nearly all participants had detectable activity in a pseudovirus neutralization assay, 2 with 50% inhibitory dilution (ID50) GMTs of 80 (95% CI, 40 to 135), 57 (95% CI, 30 to 106), and 59 (95% CI, 29 to 121), respectively. On the more sensitive live-virus focus-reduction neutralization mNeonGreen test, 4 all the participants had detectable activity, with ID50 GMTs of 361 (95% CI, 258 to 504), 171 (95% CI, 95 to 307), and 131 (95% CI, 69 to 251), respectively; these GMTs were lower in participants 56 to 70 years of age (P=0.03) and in those 71 years of age or older (P=0.005) than in those 18 to 55 years of age (Figure 1; also see the Supplementary Appendix, available with the full text of this letter at NEJM.org). The estimated half-life of binding antibodies after day 43 for all the participants was 52 days (95% CI, 46 to 58) calculated with the use of an exponential decay model, which assumes a steady decay rate over time, and 109 days (95% CI, 92 to 136) calculated with the use of a power-law model (at day 119), which assumes that decay rates decrease over time. The neutralizing antibody half-life estimates in the two models were 69 days (95% CI, 61 to 76) and 173 days (95% CI, 144 to 225) for pseudovirus neutralization and 66 days (95% CI, 59 to 72) and 182 days (95% CI, 153 to 254) for live-virus neutralization. As measured by ΔAICc (change in Akaike information criterion, corrected for small sample size), the best fit for binding and neutralization were the power-law and exponential decay models, respectively (see the Supplementary Appendix). These results are consistent with published observations of convalescent patients with Covid-19 through 8 months after symptom onset. 5 Although the antibody titers and assays that best correlate with vaccine efficacy are not currently known, antibodies that were elicited by mRNA-1273 persisted through 6 months after the second dose, as detected by three distinct serologic assays. Ongoing studies are monitoring immune responses beyond 6 months as well as determining the effect of a booster dose to extend the duration and breadth of activity against emerging viral variants. Our data show antibody persistence and thus support the use of this vaccine in addressing the Covid-19 pandemic.

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Durability of mRNA-1273 vaccine–induced antibodies against SARS-CoV-2 variants

Amarendra Pegu, Sarah O’Connell, Stephen D Schmidt … (2021)

SARS-CoV-2 mutations may diminish vaccine-induced protective immune responses, particularly as antibody titers wane over time. Here, we assess the impact of SARS-CoV-2 variants B.1.1.7 (Alpha), B.1.351 (Beta), P.1 (Gamma), B.1.429 (Epsilon), B.1.526 (Iota), and B.1.617.2 (Delta) on binding, neutralizing, and ACE2-competing antibodies elicited by the vaccine mRNA-1273 over seven months. Cross-reactive neutralizing responses were rare after a single dose. At the peak of response to the second vaccine dose, all individuals had responses to all variants. Binding and functional antibodies against variants persisted in most subjects, albeit at low levels, for 6-months after the primary series of the mRNA-1273 vaccine. Across all assays, B.1.351 had the lowest antibody recognition. These data complement ongoing studies to inform the potential need for additional boost vaccinations.

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British Society of Gastroenterology guidance for management of inflammatory bowel disease during the COVID-19 pandemic

Nicholas Kennedy, Gareth‐Rhys Jones, Christopher Lamb … (2020)

The COVID-19 pandemic is putting unprecedented pressures on healthcare systems globally. Early insights have been made possible by rapid sharing of data from China and Italy. In the UK, we have rapidly mobilised inflammatory bowel disease (IBD) centres in order that preparations can be made to protect our patients and the clinical services they rely on. This is a novel coronavirus; much is unknown as to how it will affect people with IBD. We also lack information about the impact of different immunosuppressive medications. To address this uncertainty, the British Society of Gastroenterology (BSG) COVID-19 IBD Working Group has used the best available data and expert opinion to generate a risk grid that groups patients into highest, moderate and lowest risk categories. This grid allows patients to be instructed to follow the UK government’s advice for shielding, stringent and standard advice regarding social distancing, respectively. Further considerations are given to service provision, medical and surgical therapy, endoscopy, imaging and clinical trials.

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Author and article information

Journal

Journal ID (nlm-ta): Prz Gastroenterol

Journal ID (iso-abbrev): Prz Gastroenterol

Journal ID (publisher-id): PG

Title: Przegla̜d Gastroenterologiczny

Publisher: Termedia Publishing House

ISSN (Print): 1895-5770

ISSN (Electronic): 1897-4317

Publication date (Electronic): 27 July 2023

Publication date (Print): 2024

Volume: 19

Issue: 2

Pages: 198-205

Affiliations

[1 ]Clinical Department of Internal Medicine and Gastroenterology with Inflammatory Bowel Disease Unit, National Medical Institute of the Ministry of the Interior and Administration, Warsaw, Poland

[2 ]Department of Internal Medicine, Faculty of Health Science, Medical University of Warsaw, Warsaw, Poland

[3 ]Collegium Medicum, Jan Kochanowski University, Kielce, Poland

Author notes

Address for correspondence: Konrad Lewandowski MD, PhD, Clinical Department of Internal Medicine and Gastroenterology with Inflammatory Bowel Disease Unit, National Medical Institute of the Ministry of the Interior and Administration, 137 Woloska St, 02-507 Warsaw, Poland, phone: +47 722 12 40, e-mail: dr.k.lewandowski@ 123456icloud.com

Article

Publisher ID: 51179

DOI: 10.5114/pg.2023.130126

PMC ID: 11200064

SO-VID: ac36a483-b55e-47b2-919c-7d117f2d6cae

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0). License ( http://creativecommons.org/licenses/by-nc-sa/4.0/)

SARS-CoV-2 vaccination in inflammatory bowel disease (IBD) patients – does treatment for IBD negatively affect SARS-CoV-2 antibodies? A single-centre, prospective study

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Abstract

Introduction

Aim

Material and methods

Results

Conclusions

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Novel Coronavirus Disease COVID-19

Most cited references 36

Antibody Persistence through 6 Months after the Second Dose of mRNA-1273 Vaccine for Covid-19

Durability of mRNA-1273 vaccine–induced antibodies against SARS-CoV-2 variants

British Society of Gastroenterology guidance for management of inflammatory bowel disease during the COVID-19 pandemic

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