Michael D Kappelman1,2, Kimberly N Weaver3, Xian Zhang1, Xiangfeng Dai2, Runa Watkins4, Jeremy Adler5, Marla C Dubinsky6, Arthur Kastl7, Athos Bousvaros8, Jenifer A Strople9, Raymond K Cross10, Peter D R Higgins11, Ryan C Ungaro12, Meenakshi Bewtra13, Emanuelle A Bellaguarda14, Francis A Farraye15, Margie E Boccieri1, A Firestine1, Kelly Y Chun16, Manory Fernando16, Monique Bastidas16, Michael Zikry16, Millie D Long2,3. 1. Department of Pediatrics, Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. 2. Center for Gastrointestinal Biology and Disease, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. 3. Department of Medicine, Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. 4. Division of Pediatric Gastroenterology & Nutrition, University of Maryland School of Medicine, Baltimore, Maryland, USA. 5. Susan B. Meister Child Health Evaluation and Research Center and Department of Pediatrics, Division of Pediatric Gastroenterology, University of Michigan, Ann Arbor, Michigan, USA. 6. Department of Pediatrics, Susan and Leonard Feinstein IBD Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA. 7. Division of Gastroenterology, Children's Hospital of Philadelphia, Perelman School of Medicine, Philadelphia, Pennsylvania, USA. 8. Boston Children's Hospital, Boston, Massachusetts, USA. 9. Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA. 10. Division of Gastroenterology and Hepatology, University of Maryland School of Medicine, Baltimore, Maryland, USA. 11. Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan, USA. 12. Susan and Leonard Feinstein IBD Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA. 13. Department of Biostatistics and Epidemiology, Division of Gastroenterology, University of Pennsylvania, Philadelphia, Pennsylvania, USA. 14. Division of Gastroenterology and Hepatology, Northwestern University, Chicago, Illinois, USA. 15. Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA. 16. Esoterix Specialty Laboratory, LabCorp, Calabasas, California, USA.
Abstract
INTRODUCTION: Although an additional coronavirus disease 2019 vaccine dose for immunocompromised persons has been recommended in some countries, further data to guide vaccination strategies for patients with inflammatory bowel disease (IBD) are urgently needed. We sought to identify factors affecting initial humoral immune response to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines among patients with IBD. METHODS: In this prospective cohort of SARS-CoV-2 immunized patients with IBD, we evaluated associations between participant age, sex, vaccine type, medication use, and the presence of a detectable antireceptor binding domain antibody and quantitative antibody level. RESULTS: In total, 1,909 participants were included (1,123, 692, and 94 received BNT162b2, mRNA-1273, and Ad26.COV2.S, respectively) of whom 96% achieved a positive antibody response. On multivariable analysis, factors associated with lack of antibody response were older age (P = 0.043), BNT162b2 vs mRNA-1273 (odds ratio [OR] 2.1, 95% confidence interval [CI] 1.0-3.9), and combination therapy with anti-TNF and 6MP, azathioprine, or methotrexate (OR 4.2, 95% CI 2.4-7.3). The use of 5-aminosalicylate or sulfasalazine (OR 0.3, 95% CI 0.1-0.8) and ustekinumab (OR 0.2, 95% CI 0.05-0.8) was associated with decreased odds of lacking antibody response. DISCUSSION: Most patients with IBD mount an initial response to SARS-CoV-2 vaccination; however, older patients and those treated with anti-TNF and immunomodulator have blunted responses and may benefit the most from an additional vaccine dose. Patients treated with other classes of immunosuppressive medications have more robust initial immune responses to vaccination. These data should inform key decisions about patient selection for additional coronavirus disease 2019 vaccine doses in patients with IBD.
INTRODUCTION: Although an additional coronavirus disease 2019 vaccine dose for immunocompromised persons has been recommended in some countries, further data to guide vaccination strategies for patients with inflammatory bowel disease (IBD) are urgently needed. We sought to identify factors affecting initial humoral immune response to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines among patients with IBD. METHODS: In this prospective cohort of SARS-CoV-2 immunized patients with IBD, we evaluated associations between participant age, sex, vaccine type, medication use, and the presence of a detectable antireceptor binding domain antibody and quantitative antibody level. RESULTS: In total, 1,909 participants were included (1,123, 692, and 94 received BNT162b2, mRNA-1273, and Ad26.COV2.S, respectively) of whom 96% achieved a positive antibody response. On multivariable analysis, factors associated with lack of antibody response were older age (P = 0.043), BNT162b2 vs mRNA-1273 (odds ratio [OR] 2.1, 95% confidence interval [CI] 1.0-3.9), and combination therapy with anti-TNF and 6MP, azathioprine, or methotrexate (OR 4.2, 95% CI 2.4-7.3). The use of 5-aminosalicylate or sulfasalazine (OR 0.3, 95% CI 0.1-0.8) and ustekinumab (OR 0.2, 95% CI 0.05-0.8) was associated with decreased odds of lacking antibody response. DISCUSSION: Most patients with IBD mount an initial response to SARS-CoV-2 vaccination; however, older patients and those treated with anti-TNF and immunomodulator have blunted responses and may benefit the most from an additional vaccine dose. Patients treated with other classes of immunosuppressive medications have more robust initial immune responses to vaccination. These data should inform key decisions about patient selection for additional coronavirus disease 2019 vaccine doses in patients with IBD.
Authors: Alexander M Xu; Dalin Li; Joseph E Ebinger; Emebet Mengesha; Rebecca Elyanow; Rachel M Gittelman; Heidi Chapman; Sandy Joung; Gregory J Botwin; Valeriya Pozdnyakova; Philip Debbas; Angela Mujukian; John C Prostko; Edwin C Frias; James L Stewart; Arash A Horizon; Noah Merin; Kimia Sobhani; Jane C Figueiredo; Susan Cheng; Ian M Kaplan; Dermot P B McGovern; Akil Merchant; Gil Y Melmed; Jonathan Braun Journal: Front Immunol Date: 2022-04-08 Impact factor: 8.786
Authors: Kimberly N Weaver; Xian Zhang; Xiangfeng Dai; Wenli Chen; Runa Watkins; Jeremy Adler; Marla C Dubinsky; Arthur Kastl; Athos Bousvaros; Jennifer A Strople; Raymond K Cross; Peter D R Higgins; Ryan C Ungaro; Meenakshi Bewtra; Emanuelle Bellaguarda; Francis A Farraye; Riley Craig; Cristian Hernandez; Margie E Boccieri; Ann Firestine; Kelly Y Chun; Millie D Long; Michael D Kappelman Journal: Inflamm Bowel Dis Date: 2022-07-13 Impact factor: 7.290