Holding IBD therapy for COVID-19 vaccine ‘does not impact’ infection, hospitalization risk
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CHARLOTTE, N.C. — Withholding immunosuppressive therapy prior to or following COVID-19 vaccination did not impact the rate of breakthrough infection or hospitalizations in patients with inflammatory bowel disease, noted a presenter here.
“Individuals on biologic and immunomodulating agents were excluded from clinical trials of the BNT162b2, or the Pfizer vaccine, and the mRNA-1273, or Moderna vaccine. However, the ACG strongly supports COVID-19 vaccination in this population,” Kiran K. Motwani, MD, internal medicine specialist at the University of Maryland Medical Center, told attendees during the ACG Annual Scientific Meeting. “We have also seen an attenuated antibody response in patients treated with anti-TNF therapy compared to those on vedolizumab, and prior studies have suggested perhaps holding biologic therapy to increase immunogenicity.”
To evaluate the effect of holding IBD medication around the time of COVID-19 vaccination on antibody response and subsequent infection, Motwani and colleagues analyzed 1,768 patients with IBD (69% Crohn’s disease, 73% women) from the PREVENT-COVID prospective cohort. They quantified the measurement of anti-receptor binding domain (anti-RBD) IgG antibodies 8 weeks following the vaccine series. At the time of study, 49% of patients were on anti-tumor necrosis factor monotherapy, 11% were on combination anti-TNF and immunomodulator therapy, 11% were on vedolizumab and 14% were on ustekinumab; Motwani noted 11% of patients held therapy before or after vaccine administration.
According to study results, anti-RBD antibody titers did not differ among those who continued vs. held anti-TNF before or after the vaccination series regardless of vaccine type (BNT162b2: 9.9 mg/mL vs. 10.2 mg/mL; mRNA-1273: 17 mg/mL vs. 14 mg/mL). This trend persisted among those on combination therapy (5.3 mg/mL vs. 4 mg/mL and 15 µg/mL vs. 18 mg/mL, respectively). Further analysis showed higher antibody titers among those on ustekinumab/vedolizumab compared with patients treated with different therapies which were increased in those that held therapy around the time of vaccination (22 mg/mL vs. 29 mg/mL and 51 mg/mL vs. 88.5 mg/mL).
Additionally, holding therapy did not correlate with a decreased rate of breakthrough infection compared with those not holding therapy (24% vs. 24% and 13% vs. 20%).
“Continuing vs. holding IBD therapy before or after mRNA COVID-19 vaccines has no significant impact on antibody titers,” Motwani said. “Holding immunosuppressive therapy before or after vaccination does not impact the rate of COVID-19 infections or hospitalizations and we did not see a significant increase in flare of disease at 60 days or 6 months with holding therapy. We recommend continuing IBD medications without interruption while receiving mRNA COVID-19 vaccination.”
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Motwani K, et al. Abstract S720: Impact of holding immunosuppressive therapy in patients with inflammatory bowel disease (IBD) around the time of mRNA COVID-19 vaccine administration on humoral immune response and development of COVID-19 infection. Presented at: ACG Annual Scientific Meeting; Oct. 21-26, 2022; Charlotte (hybrid meeting).
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