Humoral Immunity in Immunosuppressed IBD Patients after the Third SARS-CoV-2 Vaccination: A Comparison with Healthy Control Subjects

• Published in: Vaccines (Basel) Vol. 11; no. 9; p. 1411
• Main Authors: Vollenberg, Richard, Lorentzen, Eva Ulla, Kühn, Joachim, Nowacki, Tobias Max, Meier, Jörn Arne, Trebicka, Jonel, Tepasse, Phil-Robin
• Format: Journal Article
• Language: English
• Published: Basel MDPI AG 24.08.2023; MDPI
• Subjects: Analysis; Antibodies; Antigens; Azathioprine; Binding; Body mass index; Complications and side effects; Coronaviruses; COVID-19; COVID-19 vaccines; Crohns disease; Diagnosis; Drug dosages; Hospitals; humoral immune response; Humoral immunity; IBD patients; IgG antibody; Immune response; Immunity; Immunoglobulin G; Infections; Inflammatory bowel disease; Inflammatory bowel diseases; Infliximab; Monoclonal antibodies; Mortality; mRNA; mRNA vaccines; Neutralization; Pandemics; Patients; Respiratory diseases; SARS-CoV-2; seroconversion; Severe acute respiratory syndrome coronavirus 2; Spike protein; Therapy; Tumor necrosis factor-α; Vaccination; Viral diseases; Viruses; Germany; United States > US; Chicago Illinois
• ISSN: 2076-393X; 2076-393X
• DOI: 10.3390/vaccines11091411

Introduction: The COVID-19 pandemic is a result of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Vaccination against COVID-19 is crucial for preventing severe illness and controlling the pandemic. This study aimed to examine how immunosuppressed patients with inflammatory bowel disease (IBD) responded to the third mRNA vaccination against SARS-CoV-2. The patients were undergoing treatments such as anti-TNF (infliximab, adalimumab), anti-α4ß7 integrin (vedolizumab), anti-IL12/23 (ustekinumab) and azathioprine (purine analog). Their responses were compared to those of healthy individuals. Methods: In this prospective study, 81 IBD patients and 15 healthy controls were enrolled 2–4 months after receiving the third mRNA vaccination. This study measured IgG antibody levels against the SARS-CoV-2 spike protein’s receptor binding domain (RBD) and assessed potential neutralization capacity using a surrogate virus neutralization test (sVNT). Results: Overall, immunosuppressed IBD patients (without SARS-CoV-2 infection) exhibited significantly lower levels of anti-S-IgG (anti-RBD-IgG) and binding inhibition in the sVNT after the third vaccination compared to healthy controls. Patients under anti-TNF therapy showed notably reduced anti-S-IgG levels after the booster vaccination, in contrast to those receiving ustekinumab and azathioprine (p = 0.030, p = 0.031). IBD patients on anti-TNF therapy demonstrated significantly increased anti-S-IgG levels following prior SARS-CoV-2 infection (p = 0.020). Conclusion: Even after the third vaccination, immunosuppressed IBD patients exhibited diminished humoral immunity compared to healthy controls, especially those on anti-TNF therapy. Cases of penetrating infections led to considerably higher antibody levels in IBD patients under anti-TNF therapy compared to uninfected patients. Further investigation through prospective studies in immunosuppressed IBD patients is needed to determine whether this effectively safeguards against future infections or severe disease.