Infliximab treatment for IBD linked to attenuated anti-COVID-19 antibody responses
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Anti-COVID-19 antibody responses are attenuated in patients who receive infliximab for inflammatory bowel disease, according to a speaker at the 2021 Interdisciplinary Autoimmune Summit.
“Besides long-haul COVID-19, what I think is going to be another major aspect going forward is the issue of whether or not our medications impact on the antibody response to the virus,” Stephen B. Hanauer, MD, professor of medicine at the Northwestern University Feinberg School of Medicine, and medical director of the Northwestern Medicine Digestive Health Center, in Chicago, told attendees at the virtual conference.
During an educational session on COVID-19 updates within the realm of immune-mediated inflammatory diseases, Hanauer discussed a recent study published in Gut from Nicholas A. Kennedy, MBBS, MA, Cantab, FRACP, of the University of Exeter in the U.K., and colleagues, who concluded that infliximab (Remicade, Janssen) is associated with reduced serological responses to COVID-19 that were further blunted by immunomodulators used as concomitant therapy.
“In inflammatory bowel disease, we actually have two different types of biologic therapy — we have several biologics, but two discrete types,” Hanauer said. “There are the anti-TNF agents, which are systemic, such as infliximab, versus vedolizumab, a gut-specific antibody that prevents leukocytes from entering into the mucosa within the gut.”
Kennedy and colleagues enrolled a total of 6,935 patients with IBD from 92 centers in the United Kingdom and compared antibody responses in those treated with infliximab to those receiving vedolizumab (Entyvio, Takeda). According to Hanauer, the rates of symptomatic and proven COVID-19 were similar between the two treatment groups. However, seroprevalence, seroconversion and the magnitude of anti-COVID-19 antibody reactivity were significantly reduced in patients who received infliximab, compared with those treated with vedolizumab.
In addition, the use of concomitant immunomodulators, with a thiopurine or methotrexate further attenuated serological responses to COVID-19 in those treated with infliximab, with just one-third of said patients demonstrating detectable anti-COVID-19 antibodies.
“What you can see in comparing the uptake of titers in patients on infliximab, compared to patients on vedolizumab, the systemic agent appears to impede the immune response,” Hanauer said. “This is what I think we are going to be looking at next. We already have a consortium of IBD doctors led again from North Carolina, where we are going to look across the inflammatory bowel diseases, and the different medications our patients are taking, to look at the uptake.”
“We’ve already heard that it’s anticipated that Johnson & Johnson’s and other vaccines may be needed to be administered subsequently at 6 or 12 months, or to be determined, but whether or not our drugs should be held around these vaccines, or whether patients are going to need additional vaccine, is also to be determined,” he added. “I’m aware of one patient of mine who’s had a kidney transplant and actually had zero response to two of the Pfizer vaccines, so I think medications may be an issue in the future, and it certainly needs to be looked at.”
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Hanauer SB. Gastrointestinal Aspects of SARS-CoV-2 (COVID-19) Infections: Before, During and After the Pandemic: Change is in the Wind (and Aerosols). Presented at: Interdisciplinary Autoimmune Summit. April 15-18, 2021 (virtual meeting).
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