Third COVID vaccine provides ‘significant boost’ in antibody response in patients with IBD

September 30, 2022

2 min read

Alexander reports a financial relationship with Vifor Pharma. Please see the study for all other authors’ relevant financial disclosures.

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Immunosuppressed patients with inflammatory bowel disease who received a third COVID-19 vaccine demonstrated improved antibody binding, although the response was reduced in patients receiving infliximab and tofacitinib.

In a study published in The Lancet Gastroenterology and Hepatology, researchers noted that since patients with IBD were not included in COVID-19 vaccine trials, there are limited data on vaccine efficacy in these patients. Reports have since revealed that patients taking infliximab or tofacitinib had reduced antibody responses to the vaccines — even after a second dose — compared with healthy controls.

Source: Adobe Stock.
Source: Adobe Stock.

“Evidence is emerging that antibody concentrations decrease more rapidly in patents with IBD treated with anti-TNF drugs and that these patients are a greater risk of breakthrough infection following two doses of vaccine than patients with IBD treated with vedolizumab,” James L. Alexander, PhD, a clinical lecturer in the department of metabolism, digestion and reproduction at Imperial College London, and colleagues wrote.

To examine the effects of a third vaccine dose in patients with IBD, researchers conducted a prospective, case-control study at nine U.K. centers from Oct. 18, 2021, to March 29, 2022. They included 280 patients with IBD, aged 18 years or older, who were on one of six immunosuppressive regimens for at least 12 weeks when they received their first COVID-19 vaccine. Treatments included thiopurine (n = 65), infliximab (n = 46), thiopurine plus infliximab (n = 49), ustekinumab (n = 44), vedolizumab (n = 50) and tofacitinib (n = 26). Seventy-two healthy individuals were included as controls.

All participants received three doses of a COVID-19 vaccine, and researchers measured SARS-CoV-2 spike antibody binding and T-cell responses in all groups.

After receiving the third vaccine dose, all participants had increased geometric mean anti-SARS-CoV-2 S1 receptor binding domain antibody concentrations, but significantly lower concentrations were reported in patients treated with infliximab (2,736.8 U/mL), thiopurine plus infliximab (1,818.3 U/mL) and tofacitinib (8,071.5 U/mL) compared with the control group (16,774.2 U/mL). Patients treated with thiopurine (12,019.7 U/mL), ustekinumab (11,089.3 U/mL) or vedolizumab (13,564.9 U/mL) did not have significantly different anti-SARS-CoV-2 S1 RBD antibody concentrations compared with the control group.

“The first key finding is that patients with IBD on each of the six treatment regimens studied gain a significant boost in antibody binding levels from a third vaccine dose, supporting the decision taken in many countries to roll out third primary doses of vaccine to these groups,” Alexander and colleagues wrote.

Patients on tofacitinib additionally showed reduced vaccine-induced T-cell immunity against ancestral spike, raising the question of whether this group is particularly susceptible to infection by SARS-CoV-2,” they added.

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