Symptom frequency, severity lower after third SARS-CoV-2 mRNA vaccine vs. second in IBD
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SAN DIEGO — Patients with inflammatory bowel disease experienced reduced symptom frequency and severity after a third SARS-CoV-2 mRNA vaccine compared with after a second, according to data presented at Digestive Disease Week 2022.
“Our group and others have shown that symptoms after SARS-CoV-2 vaccination in those that receive primary vaccination with two doses of an mRNA vaccine in IBD are generally similar to the general population, and that symptoms after a second dose are more frequent and severe than after the first dose,” Angela Mujukian, MD, a postgraduate researcher at Cedars-Sinai Medical Center in Los Angeles, said during a presentation. “However, the frequency and severity of post-vaccination symptoms after the third mRNA COVID dose in IBD is unknown.”
Seeking to better understand the risk for post-vaccination symptoms after a third mRNA dose in this patient population, Mujukian and colleagues performed a prospective study of patients referred from IBD centers in the U.S. and through a Crohn's and Colitis Foundation social media campaign. Post-vaccination symptoms, frequency and severity after the third vaccine served as the primary outcomes.
Investigators evaluated 11 organ systems and graded them as mild, moderate, severe or needing hospitalization. They defined symptoms as severe-plus if they affected patient quality of life or daily activities or required hospitalization.
Of 524 patients (70% women; average age, 45 years) included in the study, 70% had Crohn’s disease and 89% were on biologic therapies at the time of initial vaccination. Participants were further stratified as younger than 55 years (n = 387) or older than 55 years (n = 137).
According to Mujukian, pain at the injection site was the most common symptom overall and was reported in 40% of patients. Symptoms were reported less after dose three compared with dose two, except for gastrointestinal symptoms and lymph node swelling. Similarly, patients who reported severe symptoms were more likely to have less severe symptoms after the third dose compared with the second. Common systemic symptoms included fatigue or malaise in 34%; headache in 23%; muscle, bone or joint pain in 13%; and nausea, vomiting or diarrhea in 9%, all of which were less frequent after the third dose vs. the second dose.
Investigators also observed that older age correlated with fewer local injection site and systemic symptoms, including less fatigue or malaise; headache; eye, ear, nose and throat symptoms; GI symptoms; and sleep symptoms. There were no reports of thromboses, myocarditis or new autoimmune disease after the third dose.
Mujukian noted that 60% of patients did not report any severe symptoms, and younger patients were twice as likely to experience severe-plus symptoms after the third dose compared with older patients.
Further, investigators found that severe-plus symptoms after the second dose did not predict severe-plus symptoms after the third dose, with only 16% of patients experiencing severe-plus symptoms after the second dose and 13% after the third dose. In all, 34% of participants who experienced severe-plus symptoms after the second dose also experienced severe-plus symptoms after the third dose. Nearly 75% of participants did not report any severe symptoms or reported mild symptoms.
“Symptom frequency and severity after a third mRNA vaccine dose are similar or lower than after a second dose,” Mujukian concluded. “This data can be reassuring to patients with IBD and providers.”
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Mujukian A, et al. Abstract 656. Presented at: Digestive Disease Week; May 21-24, 2022; San Diego (hybrid meeting).
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