Vaccination against SARS-CoV-2 in Patients with Inflammatory Bowel Diseases: Where Do We Stand?

Abstract

Crohn's disease and ulcerative colitis are chronic inflammatory bowel diseases (IBDs). Immunosuppressive medication is the main therapeutic approach to reducing inflammation of the gastrointestinal tract. Immunocompromised patients are more vulnerable to severe courses of illness after infection with common pathogens. The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is the pathogen of the coronavirus disease 2019 (COVID-19) pandemic. COVID-19 leads to acute respiratory distress syndrome (ARDS) following severe pulmonal damage in a significant number of cases. The worldwide circulation of SARS-CoV-2 has led to major concerns about the management of IBD patients during the pandemic, as these patients are expected to be at greater risk of complications because of their underlying altered immunological condition and immunosuppressive therapies. Vaccination against SARS-CoV-2 is considered the main approach in containing the pandemic. Today, several vaccines have been shown to be highly effective in the prevention of SARS-CoV-2 infection and severe disease course in subjects without underlying conditions in respective registration studies. Patients with underlying conditions such as IBD and/or immunosuppressive therapies were not included in the registration studies, so little is known about effectiveness and safety of SARS-CoV-2 vaccination in immunocompromised IBD patients. This review provides an overview of the recent knowledge about vaccine response in IBD patients after vaccination against SARS-CoV-2.

Keywords: COVID-19; Crohn’s disease; IBD; SARS-CoV-2; ulcerative colitis; vaccination.

Figure 1

Seroconversion rates after the first and second SARS CoV-2 vaccination in IBD patients; 1. Vacci., first vaccination; 2. Vacci., second vaccination; OX, ChAdOx1; BNT, BNT162b2; MOD, mRNA-1273; JJ, Ad26.CoV2.S; IBD, inflammatory bowel disease.

Figure 2

(a) Metanalysis of seroconversionrates after first vaccination (Kennedy et al., Reuken et al.; n = 895) and second vaccination (Kennedy et al., Reuken et al.; Kappelmann et al., Wong et al., Podzdyakova et al., Spencer et al.; n = 667). (b) Percentage of IBD patients on therapy with an anti-TNF α antibody, vedolizumab, ustekinumab, or other unspecified agents at the time of the first SARS-CoV-2 vaccination. (c) Percentage of IBD patients on therapy with an anti-TNF α antibody, vedolizumab, ustekinumab, or other unspecified agents at the time of the second SARS-CoV-2 vaccination. A significant number of therapies were not exactly defined or differentiated (black) by the original literature.