Research suggests early, repeat COVID vaccination for those on infliximab, tofacitinib
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Immunogenicity of the COVID-19 vaccine varied in patients with inflammatory bowel disease based on immunosuppressive drug therapy, according to research published in The Lancet Gastroenterology and Hepatology.
“The efficacy of SARS-CoV-2 vaccines in patients treated with immunosuppressive therapies remains uncertain. ... Although immunosuppressive therapy is the cornerstone of IBD management, there are concerns that some of these treatments might impair the protective immune responses elicited to various vaccines,” James L. Alexander, PhD, of the department of metabolism, digestion and reproduction at the Imperial College London, and colleagues wrote. “It is not yet known what effect other commonly used therapies in IBD, including thiopurines, anti-IL-12 and anti-IL-23 therapies and JAK inhibitors, have on immune responses to SARS-CoV-2 vaccination.”
In a multicenter, prospective, case-controlled study, researchers aimed to determine whether immunosuppressive drug regimens altered immunogenicity to SARS-CoV-2 vaccination in IBD patients. They enrolled 362 patients from nine centers in the United Kingdom who were treated with thiopurines (78), infliximab (63), thiopurine with infliximab (72), ustekinumab (57), vedolizumab (62) or tofacitinib (30), as well as 121 healthy control participants. All participants received two doses of COVID-19 vaccines; researchers measured antibody response 53 days to 92 days after the second dose. Studied outcomes included anti-SARS-CoV-2 spike protein antibody concentrations in participants without previous infection (n = 375), adjusted by age and vaccine type.
Alexander and colleagues observed lower geometric mean anti-SARS-CoV-2 spike protein antibody concentrations in patients treated with infliximab (156.8 U/mL), infliximab with thiopurine (111.1 U/mL) and tofacitinib (429.5 U/mL) compared with control participants (1,578.3 U/mL). Further, they observed no significant difference in patients treated with thiopurine monotherapy (1,019.8 U/mL), ustekinumab (582.4 U/mL) or vedolizumab (954 U/mL) compared with healthy controls.
Following multivariable analysis, lower anti-SARS-CoV-2 spike protein antibody concentrations independently associated with infliximab (geometric mean ratio: 0.12; 95% CI, 0.08-0.17) and tofacitinib use (0.43; 95% CI, 0.23-0.81) but not with ustekinumab (0.69; 95% CI, 0.41-1.19), thiopurine (0.89; 95% CI, 0.64-1.24) or vedolizumab (1.16; 95% CI, 0.74-1.83). While mRNA vaccines associated with higher antibody concentration (3.68; 95% CI, 2.8-4.84), older age per decade associated with lower antibody concentrations (0.79; 95% CI, 0.72-0.87).
“Our findings support a personalized approach to scheduling of vaccine dosing and, given the poor vaccine-induced serological responses observed in patients with IBD being treated with infliximab or tofacitinib, these individuals should be fast-tracked to early repeat vaccine dosing,” Alexander and colleagues concluded. “The increased magnitude of response elicited by mRNA versus adenovirus vaccines indicates that strategies using full-dose mRNA vaccines might be favored in these patient groups.”
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