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. 2023 Aug 1;29(8):1202-1209.
doi: 10.1093/ibd/izac193.

Higher Cell-Mediated Immune Responses in Patients With Inflammatory Bowel Disease on Anti-TNF Therapy After COVID-19 Vaccination

Freddy Caldera  1 , Francis A Farraye  2 , Brian M Necela  3 , Davitte Cogen  3 , Sumona Saha  1 , Arnold Wald  1 , Nader D Daoud  2 , Kelly Chun  4 , Ian Grimes  1 , Megan Lutz  1 , Sean R Van Helden  5 , Melanie D Swift  6 , Abinash Virk  7 , Adil E Bharucha  8 , Tushar C Patel  9 , Gregory J Gores  8 , Saranya Chumsri  10 , Mary S Hayney  5 , Keith L Knutson  3
Affiliations

Higher Cell-Mediated Immune Responses in Patients With Inflammatory Bowel Disease on Anti-TNF Therapy After COVID-19 Vaccination

Freddy Caldera et al. Inflamm Bowel Dis. .

Abstract

Background: Some patients with inflammatory bowel disease (IBD) on immunosuppressive therapies may have a blunted response to certain vaccines, including the messenger RNA (mRNA) coronavirus disease 2019 (COVID-19) vaccines. However, few studies have evaluated the cell-mediated immune response (CMIR), which is critical to host defense after COVID-19 infection. The aim of this study was to evaluate the humoral immune response and CMIR after mRNA COVID-19 vaccination in patients with IBD.

Methods: This prospective study (HERCULES [HumoRal and CellULar initial and Sustained immunogenicity in patients with IBD] study) evaluated humoral immune response and CMIR after completion of 2 doses of mRNA COVID-19 vaccines in 158 IBD patients and 20 healthy control (HC) subjects. The primary outcome was the CMIR to mRNA COVID-19 vaccines in patients with IBD. The secondary outcomes were a comparison of (1) the CMIR in patients with IBD and HC subjects, (2) CMIR and humoral immune response in all participants, and (3) correlation between CMIR and humoral immune response.

Results: The majority (89%) of patients with IBD developed a CMIR, which was not different vs HC subjects (94%) (P = .6667). There was no significant difference (P = .5488) in CMIR between immunocompetent (median 255 [interquartile range, 146-958] spike T cells per million peripheral blood mononuclear cells) and immunosuppressed patients (median 377 [interquartile range, 123-1440]). There was no correlation between humoral and cell-mediated immunity after vaccination (P = .5215). In univariable analysis, anti-tumor necrosis factor therapy was associated with a higher CMIRs (P = .02) and confirmed in a multivariable model (P = .02). No other variables were associated with CMIR.

Conclusions: Most patients with IBD achieved CMIR to a COVID-19 vaccine. Future studies are needed evaluating sustained CMIR and clinical outcomes.

Keywords: Crohn’s disease; immune response; ulcerative colitis.

Plain language summary

Antibody and T cell responses to coronavirus disease 2019 vaccines in patients with inflammatory bowel disease do not correlate. Most patients with inflammatory bowel disease mount a T cell response despite being on biologic therapies, those on anti-tumor necrosis factor may have a higher T cell response. Anti-tumor necrosis factor therapy has been associated with a lower antibody response to coronavirus disease 2019 vaccines, but the T cell response is augmented.

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Figures

Figure 1.
Figure 1.
Humoral and cell mediated immune responses in inflammatory bowel disease (IBD) patients and normal healthy individuals following vaccination. A, Box-and-whisker plot comparing spike-specific T cell levels (per million peripheral blood mononuclear cells [PBMCs]) in all IBD patients and normal healthy control subjects. The P value was calculated using the Mann-Whitney test. B, Correlation plot comparing paired antibody (µg/mL serum) and spike-specific T cell (per million PBMCs) levels in patients with IBD. The P value and r correlation coefficient were calculated using the Spearman correlation test. C and D, Box-and-whisker plot comparing spike-specific antibody levels (µg/mL serum) and spike-specific T cell (per million PBMCs) levels in IBD patients treated with either nonimmunosuppressive or immunosuppressive regimens. The P values were calculated using the Mann-Whitney test. Each symbol represents a unique patient or healthy donor.
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References

    1. Rolak S, Hayney MS, Farraye FA, Temte JL, Caldera F.. What gastroenterologists should know about COVID-19 vaccines. Clin Gastroenterol Hepatol. 2021;19(4):657–661. - PMC - PubMed
    1. Chumsri S, Advani PP, Pai TS, et al. . Humoral responses after SARS-CoV-2 mRNA vaccination and breakthrough infection in cancer patients. Mayo Clin Proc Innov Qual Outcomes. 2022;6(2):120–125. - PMC - PubMed
    1. Caldera F, Ley D, Hayney MS, Farraye FA.. Optimizing immunization strategies in patients with IBD. Inflamm Bowel Dis. 2021;27(1):123–133. - PubMed
    1. Caldera F, Hillman L, Saha S, et al. . Immunogenicity of high dose influenza vaccine for patients with inflammatory bowel disease on anti-TNF monotherapy: a randomized clinical trial. Inflamm Bowel Dis. 2020;26(4):593–602. - PubMed
    1. Weaver KN, Zhang X, Dai X, et al. . Impact of SARS-CoV-2 vaccination on inflammatory bowel disease activity and development of vaccine-related adverse events: results from PREVENT-COVID. Inflamm Bowel Dis. Published online December 6, 2021. doi:10.1093/ibd/izab302 - DOI - PMC - PubMed

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