Remicade blunts serological response in SARS-CoV-2
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Remicade use in inflammatory bowel disease was linked to attenuated serological response to SARs-CoV-2, which were further blunted by immunomodulators used as concomitant therapy, according to a study published in Gut.
“Impaired serological responses to SARS-CoV-2 infection might have important implications for global public health policy and individual anti-TNF–treated patients,” Nicholas A. Kennedy, MBBS, FRACP, from the department of gastroenterology at University College London Hospitals, NHS Foundation Trust in London, United Kingdom, and colleagues wrote. “Serological testing and virus surveillance should be considered to detect suboptimal vaccine responses.”
Kennedy and colleagues compared antibody responses in patients treated with Remicade (infliximab, Janssen) with a reference cohort treated with Entyvio (vedolizumab, Takeda). They recruited 6,935 patients from 92 hospitals in the U.K. from Sept. 22 through Dec. 23, 2020.
Investigators found similar rates of symptomatic and proven SARS-CoV-2 infection between groups. Patients treated with infliximab had lower seroprevalence than patients treated with vedolizumab (3.4% vs. 6%; P < .0001).
“Multivariable logistic regression analyses confirmed that infliximab (vs. vedolizumab; OR = 0.66; 95% CI, 0.51-0.87) and immunomodulator use (OR = 0.7; 95% CI, 0.53-0.92) were independently associated with lower seropositivity,” Kennedy and colleagues wrote.
Among patients with confirmed SARS-CoV-2, researchers saw less seroconversion in the infliximab cohort than the vedolizumab cohort (48% vs. 83%; P = .00044). Further, the magnitude of anti-SARS-CoV-2 reactivity was lower (P < .0001).
“Concomitant immunomodulator use with a thiopurine or methotrexate further blunted serological responses to SARS-CoV-2 infection in infliximab-treated patients, with only a third of patients having detectable anti–SARS-CoV-2 antibodies,” the investigators wrote.
Perspective
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Benjamin Cohen, MD, MAS
The study suggests that IBD patients on infliximab may have lower or less durable natural immunity following COVID-19 infection than patients on a less systemic biologic therapy, vedolizumab. While a potential implication of these results could be that IBD patients on anti-TNF therapy are more susceptible to re-infection with COVID-19 or having a less robust response to vaccination, more studies are needed.
Immunity to COVID-19 may involve both an antibody response and a cellular response through memory T cells that is more durable. Also, immune responses to vaccination are often stronger than those to natural infection necessitating studies in IBD patients on immunosuppressive medications who have been vaccinated such as the PREVENT-COVID study in the United States. Lastly, other studies have even suggested lower rates of COVID-19 infection in patients with immune mediated inflammatory diseases on anti-cytokine therapies such as anti-TNF.
While there is still much to learn, it remains critical that we encourage all patients to get COVID-19 vaccines when available and that we continue to treat our IBD patients with effective therapies such as anti-TNF agents to keep their disease under control and off steroids, which we know puts them at risk for severe COVID-19.
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