SARS-CoV-2 vaccination for patients with inflammatory bowel disease: a British Society of Gastroenterology Inflammatory Bowel Disease section and IBD Clinical Research Group position statement

Abstract

SARS-CoV-2 has caused a global health crisis and mass vaccination programmes provide the best opportunity for controlling transmission and protecting populations. Despite the impressive clinical trial results of the BNT162b2 (Pfizer/BioNTech), ChAdOx1 nCoV-19 (Oxford/AstraZeneca), and mRNA-1273 (Moderna) vaccines, important unanswered questions remain, especially in patients with pre-existing conditions. In this position statement endorsed by the British Society of Gastroenterology Inflammatory Bowel Disease (IBD) section and IBD Clinical Research Group, we consider SARS-CoV-2 vaccination strategy in patients with IBD. The risks of SARS-CoV-2 vaccination are anticipated to be very low, and we strongly support SARS-CoV-2 vaccination in patients with IBD. Based on data from previous studies with other vaccines, there are conceptual concerns that protective immune responses to SARS-CoV-2 vaccination may be diminished in some patients with IBD, such as those taking anti-TNF drugs. However, the benefits of vaccination, even in patients treated with anti-TNF drugs, are likely to outweigh these theoretical concerns. Key areas for further research are discussed, including vaccine hesitancy and its effect in the IBD community, the effect of immunosuppression on vaccine efficacy, and the search for predictive biomarkers of vaccine success.

Figure 1

SARS-CoV-2 and currently approved vaccine mechanisms Adenovirus vector vaccines are replication-incompetent viruses that have been engineered to express the SARS-CoV-2 spike protein to which the recipient immune system responds. Examples include ChAdOx1 nCoV-19, JNJ-78436735, and Sputnik-V. mRNA vaccines are delivered in a lipid nanoparticle that is taken up by cells, which translate the mRNA to generate spike protein. Examples include BNT162b2, mRNA-1273, and COVAC1.

Figure 2

Summary of studies of immunogenicity of vaccines in patients taking immunosuppressive therapies (A) Pneumococcal vaccine response rate (response measured as a two-fold increase in anti-pneumococcal antibody titre) is reduced in patients administered anti-TNF monotherapy (58%) and immunomodulator and anti-TNF combination therapy (63%) relative to 5-ASA treated controls (89%). Asterisks denote statistically significant difference vs controls. (B) 2009 H1N1 influenza vaccination response rate (response measured as a ≥40% haemagluttinin inhibition [HI] titre) is attenuated in patients on immunomodulator and anti-TNF combination therapy (36%) relative to non-immunosuppressed controls (64%). Asterisk denotes statistically significant difference vs controls. (C) Heatmap adapted from studies of responses to vaccination in patients on immunomodulator or anti-TNF therapy showing percentage reduction in seroprotection to pneumococcal,, hepatitis B virus (HBV), hepatitis A virus (HAV), and influenza H1N1, H3N2, and B., 5=ASA=5-aminosalicylic acid.