Anti-SARS-CoV-2 antibody responses are attenuated in patients with IBD treated with infliximab. Issue 5 (22nd March 2021)

• Record Type: Journal Article
• Authors: Kennedy, Nicholas A; Goodhand, James R; Bewshea, Claire; Nice, Rachel; Chee, Desmond; Lin, Simeng; Chanchlani, Neil; Butterworth, Jeffrey; Cooney, Rachel; Croft, Nicholas M; Hart, Ailsa L; Irving, Peter M; Kok, Klaartje B; Lamb, Christopher A; Limdi, Jimmy K; Macdonald, Jonathan; McGovern, Dermot PB; Mehta, Shameer J; Murray, Charles D; Patel, Kamal V; Pollok, Richard CG; Raine, Timothy; Russell, Richard K; Selinger, Christian P; Smith, Philip J; Bowden, Jack; McDonald, Timothy J; Lees, Charlie W; Sebastian, Shaji; Powell, Nicholas; Ahmad, Tariq;
• Other Names: author non-byline.; Kok Klaartje author non-byline.; Bokth Farjhana author non-byline.; Cipriano Bessie author non-byline.; Francia Caroline author non-byline.; Khalid Nosheen author non-byline.; Khatun Hafiza author non-byline.; Kingston Ashley author non-byline.; Lee Irish author non-byline.; Lehmann Anouk author non-byline.; Naik Kinnari author non-byline.; Pabriaga Elise author non-byline.; Plaatjies Nicolene author non-byline.; Samuels Kevin author non-byline.; Cipriano Bessie author non-byline.; Samuels Kevin author non-byline.; Plaatjies Nicolene author non-byline.; Khatun Hafiza author non-byline.; Bokth Farjana author non-byline.; Pabriaga Elise author non-byline.; Francia Caroline author non-byline.; Saich Rebecca author non-byline.; Cousins Hayley author non-byline.; Fraser Wendy author non-byline.; Thomas Rachel author non-byline.; Brown Matthew author non-byline.; White Benjamin author non-byline.; Muhammed Rafeeq author non-byline.; Bi Rehana author non-byline.; 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• Is Part Of: Gut. Volume 70:Issue 5(2021)
• Page Start: 865
• Page End: 875
• Publication Date: 2021-03-22
• Subjects: inflammatory bowel disease -- autoimmune disease -- COVID-19 -- inflammatory diseases -- infliximab -- vedoluzimab -- clarity; Gastroenterology -- Periodicals; 616.33
• DOI: 10.1136/gutjnl-2021-324388
• Languages: English
• ISSNs: 0017-5749

Abstract

Abstract : Objective: Antitumour necrosis factor (anti-TNF) drugs impair protective immunity following pneumococcal, influenza and viral hepatitis vaccination and increase the risk of serious respiratory infections. We sought to determine whether infliximab-treated patients with IBD have attenuated serological responses to SARS-CoV-2 infections. Design: Antibody responses in participants treated with infliximab were compared with a reference cohort treated with vedolizumab, a gut-selective anti-integrin α4β7 monoclonal antibody that is not associated with impaired vaccine responses or increased susceptibility to systemic infections. 6935 patients were recruited from 92 UK hospitals between 22 September and 23 December 2020. Results: Rates of symptomatic and proven SARS-CoV-2 infection were similar between groups. Seroprevalence was lower in infliximab-treated than vedolizumab-treated patients (3.4% (161/4685) vs 6.0% (134/2250), p<0.0001). Multivariable logistic regression analyses confirmed that infliximab (vs vedolizumab; OR 0.66 (95% CI 0.51 to 0.87), p=0.0027) and immunomodulator use (OR 0.70 (95% CI 0.53 to 0.92), p=0.012) were independently associated with lower seropositivity. In patients with confirmed SARS-CoV-2 infection, seroconversion was observed in fewer infliximab-treated than vedolizumab-treated patients (48% (39/81) vs 83% (30/36), p=0.00044) and the magnitude of anti-SARS-CoV-2 reactivity was lower (median 0.8 cut-off index (0.2–5.6) vs 37.0 (15.2–76.1), p<0.0001). Conclusions: Infliximab is associated with attenuated serological responses to SARS-CoV-2 that were further blunted by immunomodulators used as concomitant therapy. Impaired serological responses to SARS-CoV-2 infection might have important implications for global public health policy and individual anti-TNF-treated patients. Serological testing and virus surveillance should be considered to detect suboptimal vaccine responses, persistent infection and viral evolution to inform public health policy. Trial registration number: ISRCTN45176516 .