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. 2022 Sep 8;16(9):1354-1362.
doi: 10.1093/ecco-jcc/jjac029.

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]

Jayne Doherty  1   2   3 , Neil O Morain  1   2 , Roisin Stack  1   2 , Parker Girod  1 , Miriam Tosetto  2 , Rosanna Inzitiari  2 , Juliette Sheridan  1   2   4 , Garret Cullen  1   2   4   3 , Edel McDermott  1   4 , Maire Buckley  1   4   5 , Gareth Horgan  1   4   6 , Hugh Mulcahy  1   2   4 , Elizabeth J Ryan  7 , David Daghfal  8 , Peter Doran  2 , Colm O Morain  9   3 , Glen A Doherty  1   2   4   3
Affiliations

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]

Jayne Doherty et al. J Crohns Colitis. .

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.

Keywords: COVID-19 vaccination; Inflammatory bowel disease; anti-tumour necrosis factor antagonists.

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