Corticosteroids decrease COVID-19 vaccine efficacy in IBD
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Though there is no significant difference in COVID-19 infection rates among patients with inflammatory bowel disease compared with the general public, some IBD therapies correlated with increased infection severity.
“The therapies for IBD are predominantly immune-based, immune modifying and sometimes immune suppressive,” David T. Rubin, MD, FACG, University of Chicago, said at the ACG Virtual Grand Rounds 2021. “There's been increased concern and fear that the therapies for IBD are increasing the risk for severe COVID-19 outcomes or might affect the response to vaccinations. In addition, CDC and FDA information is not specific to IBD and, therefore, has been confusing.”
Overall, information gleaned from studies demonstrated patients with IBD do not experience an increased risk for infection, hospitalization or death; though, these patients are not at a decreased risk either, Rubin added. Comorbidities such as age and weight continue to play a role in immunosuppressed and immunocompetent patients alike.
“The International Organization for the study of IBD published a number of consensus guidance throughout all of this,” Rubin said. “One published earlier this year (Siegel C, et al. Gut. 2021), made the following suggestions that the data now supports: patients with IBD should be vaccinated against SARS-CoV-2 and the best time to administer the vaccine is at the earliest opportunity.”
Further, recent study data supported initial analyses that while steroids associated with an increased risk for severe COVID-19 as measured by hospitalization, mechanical ventilation use and death, biologic therapy (ie, anti-tumor necrosis factor) associated with a decreased risk for severe infection and might actually be protective. Rubin noted vaccinated patients taking corticosteroids should be counseled on vaccine efficacy.
In general, response rates following two doses of the COVID-19 vaccine as labeled by the FDA among patients with IBD have been similar to the general population. However, the PREVENT-COVID study (Kappelman et al. Gastroenterology. 2021) demonstrated no significant reduction in antibody titers over time suggesting the need for an eventual booster dose. The key difference between needing a third dose and a booster dose is that the third dose is only necessary among patients who did not generate the appropriate response to the first two doses while the booster dose is meant to stimulate immune memory.
“Most patients with IBD are not considered immune suppressed and therefore should not need an additional dose right now,” Rubin concluded. “When it's time for a booster, everyone should get one, but that's not yet been recommended by the FDA and approved.”
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Rubin D. What an additional dose of the COVID-19 vaccine means for patients with IBD. Presented at: ACG Virtual Grand Rounds 2021. August 31 (virtual meeting).
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