Reduced Serological Response to COVID-19 Vaccines in Patients with IBD is Further Diminished by TNF Inhibitor Therapy; Early Results of the VARIATION study [VAriability in Response in IBD Against SARS-COV-2 ImmunisatiON]

• Published in: Journal of Crohn's and colitis Vol. 16; no. 9; pp. 1354 - 1362
• Main Authors: Doherty, Jayne, Morain, Neil O, Stack, Roisin, Girod, Parker, Tosetto, Miriam, Inzitiari, Rosanna, Sheridan, Juliette, Cullen, Garret, McDermott, Edel, Buckley, Maire, Horgan, Gareth, Mulcahy, Hugh, Ryan, Elizabeth J, Daghfal, David, Doran, Peter, Morain, Colm O, Doherty, Glen A
• Format: Journal Article
• Language: English
• Published: UK Oxford University Press 08.09.2022
• Subjects: Original; Inflammatory bowel disease; COVID-19 vaccination; anti-tumour necrosis factor antagonists; anti-tumour necrosis antagonists
• ISSN: 1873-9946; 1876-4479
• DOI: 10.1093/ecco-jcc/jjac029

Abstract Background and Aims Evidence suggests patients with inflammatory bowel disease [IBD] receiving TNF antagonists have attenuated response to vaccination against COVID-19. We sought to determine the impact of IBD and of various medications for treatment of IBD on antibody responses to vaccination against COVID-19. Methods Patients with IBD [n = 270] and healthy controls [HC, n = 116] were recruited prospectively, and quantitative antibody responses were assessed following COVID-19 vaccination. The impact of IBD and of medications for treatment of IBD on vaccine response rates was investigated. Results Of HC, 100% seroconverted following complete vaccination with two vaccine doses; 2% of patients with IBD failed to seroconvert. Median anti-spike protein [SP] immunoglobulin [Ig]G levels following complete vaccination in our IBD cohort was significantly lower than among HC [2613 AU/mL versus 6871 AU/mL, p ≤0.001]. A diagnosis of IBD was independently associated with lower anti-SP IgG levels [β coefficient -0.2, p = 0.001]. Use of mRNA vaccines was independently associated with higher anti-SP IgG levels [β coefficient 0.25, p ≤0.001]. Patients with IBD receiving TNF inhibitors had significantly lower anti-SP IgG levels [2445 AU/mL] than IBD patients not receiving TNF inhibitors [3868 AU/mL, p ≤0.001]. Patients with IBD not receiving TNF inhibitors still showed attenuated responses compared with HC [3868 AU/mL versus 8747 AU/mL, p = 0.001]. Conclusions Patients with IBD have attenuated serological responses to SARS-CoV-2 vaccination. Use of anti-TNF therapy negatively affects anti-SP IgG levels further. Patients who do not seroconvert following vaccination are a particularly vulnerable cohort. Impaired responses to vaccination in our study highlight the importance of booster vaccination programmes for patients with IBD.