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Observational Study
. 2023 Nov 2;29(11):1693-1705.
doi: 10.1093/ibd/izad097.

Geography Influences Susceptibility to SARS-CoV-2 Serological Response in Patients With Inflammatory Bowel Disease: Multinational Analysis From the ICARUS-IBD Consortium

Serre-Yu Wong  1 , Judith Wellens  2 , Drew Helmus  1 , Luke Marlow  3 , Stephanie Brann  3 , Vicky Martinez Pazos  1 , Alan Weinberg  4 , Hunter R Moran  1 , Colleen McGregor  3 , Séverine Vermeire  2 , Kenji Watanabe  5 , Koji Kamikozuru  5 , Vineet Ahuja  6 , Shubi Vermani  6 , James O Lindsay  7 , Ashley Kingston  7 , Usha Dutta  8 , Harmandeep Kaur  8 , Mark S Silverberg  9 , Raquel Milgrom  9 , Siew Chien Ng  10 , Joyce Wing Yan Mak  10 , Ken Cadwell  11   12   13 , Craig Thompson  14 , Jean-Frédéric Colombel  1 , Jack Satsangi  3 ; ICARUS-IBD Consortium
Collaborators, Affiliations
Observational Study

Geography Influences Susceptibility to SARS-CoV-2 Serological Response in Patients With Inflammatory Bowel Disease: Multinational Analysis From the ICARUS-IBD Consortium

Serre-Yu Wong et al. Inflamm Bowel Dis. .

Abstract

Background: Beyond systematic reviews and meta-analyses, there have been no direct studies of serological response to COVID-19 in patients with inflammatory bowel disease (IBD) across continents. In particular, there has been limited data from Asia, with no data reported from India. The ICARUS-IBD (International study of COVID-19 Antibody Response Under Sustained immunosuppression in IBD) consortium assessed serological response to SARS-CoV-2 in patients with IBD in North America, Europe, and Asia.

Methods: The ICARUS-IBD study is a multicenter observational cohort study spanning sites in 7 countries. We report seroprevalence data from 2303 patients with IBD before COVID-19 vaccination between May 2020 and November 2021. SARS-CoV-2 anti-spike and anti-nucleocapsid antibodies were analyzed.

Results: The highest and lowest SARS-CoV-2 anti-spike seropositivity rates were found in Asia (81.2% in Chandigarh and 57.9% in Delhi, India; and 0% in Hong Kong). By multivariable analysis, country (India: odds ratio [OR], 18.01; 95% confidence interval [CI], 12.03-26.95; P < .0001; United Kingdom: OR, 2.43; 95% CI, 1.58-3.72; P < .0001; United States: OR, 2.21; 95% CI, 1.27-3.85; P = .005), male sex (OR, 1.46; 95% CI, 1.07-1.99; P = .016), and diabetes (OR, 2.37; 95% CI, 1.04-5.46; P = .039) conferred higher seropositivity rates. Biological therapies associated with lower seroprevalence (OR, 0.22; 95% CI, 0.15-0.33; P < .0001). Multiple linear regression showed associations between anti-spike and anti-nucleocapsid titers with medications (P < .0001) but not with country (P = .3841).

Conclusions: While the effects of medications on anti-SARS-CoV-2 antibody titers in patients with IBD were consistent across sites, geographical location conferred the highest risk of susceptibility to serologically detectable SARS-CoV-2 infection. Over half of IBD patients in India were seropositive prior to vaccination. These insights can help to inform shielding advice, therapeutic choices, and vaccine strategies in IBD patients for COVID-19 and future viral challenges.

Keywords: Inflammatory bowel disease; SARS-CoV-2; seroprevalence.

Plain language summary

In this multinational study of SARS-CoV-2 seroprevalence prior to vaccination, including the first data from India, where over half of patients seroconverted, geographical location conferred the highest risk of susceptibility to serologically detectable infection.

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