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Meta-Analysis
. 2022 Jul;20(7):1456-1479.e18.
doi: 10.1016/j.cgh.2022.02.030. Epub 2022 Feb 19.

Effectiveness and Durability of COVID-19 Vaccination in 9447 Patients With IBD: A Systematic Review and Meta-Analysis

Anuraag Jena  1 , Deepak James  1 , Anupam K Singh  1 , Usha Dutta  1 , Shaji Sebastian  2 , Vishal Sharma  3
Affiliations
Meta-Analysis

Effectiveness and Durability of COVID-19 Vaccination in 9447 Patients With IBD: A Systematic Review and Meta-Analysis

Anuraag Jena et al. Clin Gastroenterol Hepatol. 2022 Jul.

Abstract

Background and aims: The serological responses after severe acute respiratory syndrome coronavirus 2 vaccination may be attenuated in immunocompromised individuals. The study aimed to systematically evaluate the seroconversion rates after complete vaccination for coronavirus disease 2019 (COVID-19) in patients with inflammatory bowel disease (IBD).

Methods: Electronic databases were searched to identify studies reporting response to COVID-19 vaccination in IBD. Pooled seroconversion rates after complete vaccination were calculated. Subgroup analysis for vaccine types was also performed. Pooled seroconversion rates for various drugs or classes were also estimated. The pooled rates of breakthrough infections in vaccinated IBD patients were estimated. The pooled neutralization rates after complete vaccination were also estimated. The studies reporting durability of titers were systematically assessed.

Results: A total of 46 studies were included. The pooled seroconversion rate for complete vaccination (31 studies, 9447 patients) was 0.96 (95% confidence interval [CI], 0.94-0.97; I2 = 90%). When compared with healthy control subjects, the pooled relative risk of seroconversion was lower (0.98; 95% CI, 0.98-0.99; I2 = 39%). The pooled seroconversion rates were statistically similar among various drug classes. The pooled positivity of neutralization assays (8 studies, 771 participants) was 0.80 (95% CI, 0.70-0.87; I2 = 82%). The pooled relative risk of breakthrough infections in vaccinated IBD patients was similar to vaccinated control subjects (0.60; 95% CI, 0.25-1.42; I2 = 79%). Most studies suggested that titers fall after 4 weeks of COVID-19 vaccination, and the decay was higher in patients on anti-tumor necrosis factor alone or combination with immunomodulators. An additional dose of COVID-19 vaccine elicited serological response in most nonresponders to complete vaccination.

Conclusions: Complete COVID-19 vaccination is associated with seroconversion in most patients with IBD. The decay in titers over time necessitates consideration of additional doses in these patients.

Keywords: Adenoviral Associated Virus; Anti-IL12/23; Anti-TNF; Crohn’s Disease; Decay; Immunization; Infliximab; Thiopurines; Ulcerative Colitis; mRNA.

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Figures

None
Graphical abstract
Figure 1
Figure 1
PRISMA flowchart showing the process of screening and selection of studies
Figure 2
Figure 2
Forest plot depicting the pooled seroconversion rates after complete COVID-19 vaccination in patients with IBD
Figure 3
Figure 3
Forest plot depicting the pooled seroconversion rates after complete COVID-19 vaccination in patients with IBD depending on the underlying treatment.
Figure 4
Figure 4
Forest plot depicting (A) the pooled rate of breakthrough infections after 2 doses of COVID-19 vaccination in patients with IBD and (B) the pooled RR of breakthrough infection in IBD patients as compared with vaccinated control subjects.
Supplementary Figure 1
Supplementary Figure 1
Pooled seroconversion rates after complete coronavirus disease 2019 (COVID-19) vaccination in patients with inflammatory bowel disease (IBD) as per the individual vaccine types. CI, confidence interval; RR, relative risk.
Supplementary Figure 2
Supplementary Figure 2
Pooled RR of seroconversion after complete COVID-19 vaccination in patients with IBD as compared with healthy control subjects with subgroup analysis.
Supplementary Figure 3
Supplementary Figure 3
Pooled seroconversion rates after incomplete COVID-19 vaccination in patients with IBD.
Supplementary Figure 4
Supplementary Figure 4
Pooled RR of seroconversion after incomplete COVID-19 vaccination in patients with IBD as compared with healthy control subjects.
Supplementary Figure 5
Supplementary Figure 5
Pooled positivity rates of neutralization assays after complete COVID-19 vaccination in patients with IBD.
Supplementary Figure 6
Supplementary Figure 6
Pooled RR of neutralization assay positivity after complete COVID-19 vaccination in patients with IBD as compared with healthy control subjects.
Supplementary Figure 7
Supplementary Figure 7
Pooled RR of seroconversion after complete COVID-19 vaccination in patients on combination therapy (anti-tumor necrosis factor [TNF] plus immunomodulators) as compared with anti-TNF drugs alone.
Supplementary Figure 8
Supplementary Figure 8
Funnel plot depicting the publication bias in studies reporting seroconversion after complete vaccination.
Supplementary Figure 9
Supplementary Figure 9
Baujat plot depicting the studies contributing to heterogeneity.
See this image and copyright information in PMC

References

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Supplementary References

    1. Al-Janabi A., Littlewood Z., Griffiths C.E.M., et al. Antibody responses to single-dose SARS-CoV-2 vaccination in patients receiving immunomodulators for immune-mediated inflammatory disease. Br J Dermatol. 2021;185:646–648. - PMC - PubMed
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