Systemic and T cell‐associated responses to SARS‐CoV‐2 immunisation in gut inflammation (STAR SIGN study): effects of biologics on vaccination efficacy of the third dose of mRNA vaccines against SARS‐CoV‐2. Issue 1 (28th October 2022)

• Record Type: Journal Article
• Authors: Woelfel, Simon; Dütschler, Joel; König, Marius; Graf, Nicole; Oikonomou, Vasileios; Krieger, Claudia; Truniger, Samuel; Franke, Annett; Eckhold, Annika; Forsch, Kristina; Wyss, Jacqueline; Krupka, Niklas; Albrich, Werner; Frei, Nicola; Geissler, Nora; Schaub, Peter; Friedrich, Matthias; Misselwitz, Benjamin; Korte, Wolfgang; Bürgi, Justus J.; Brand, Stephan
• Is Part Of: Alimentary pharmacology & therapeutics. Volume 57:Issue 1(2023)
• Page Start: 103
• Page End: 116
• Publication Date: 2022-10-28
• Subjects: Digestive organs -- Diseases -- Treatment -- Periodicals; Digestive organs -- Effect of drugs on -- Periodicals; Gastrointestinal system -- Diseases -- Treatment -- Periodicals; Gastrointestinal system -- Effect of drugs on -- Periodicals; 615.73
• DOI: 10.1111/apt.17264
• Languages: English
• ISSNs: 0269-2813

Abstract

Summary: Background: Immunosuppressed patients with inflammatory bowel disease (IBD) experience increased risk of vaccine‐preventable diseases such as COVID‐19. Aims: To assess humoral and cellular immune responses following SARS‐CoV‐2 booster vaccination in immunosuppressed IBD patients and healthy controls. Methods: In this prospective, multicentre, case–control study, 139 IBD patients treated with biologics and 110 healthy controls were recruited. Serum anti‐SARS‐CoV‐2 spike IgG concentrations were measured 2–16 weeks after receiving a third mRNA vaccine dose. The primary outcome was to determine if humoral immune responses towards booster vaccines differ in IBD patients under anti‐TNF versus non‐anti‐TNF therapy and healthy controls. Secondary outcomes were antibody decline, impact of previous infection and SARS‐CoV‐2‐targeted T cell responses. Results: Anti‐TNF‐treated IBD patients showed reduced anti‐spike IgG concentrations (geometric mean 2357.4 BAU/ml [geometric SD 3.3]) when compared to non‐anti‐TNF‐treated patients (5935.7 BAU/ml [3.9]; p < 0.0001) and healthy controls (5481.7 BAU/ml [2.4]; p < 0.0001), respectively. In multivariable modelling, prior infection (geometric mean ratio 2.00 [95% CI 1.34–2.90]) and vaccination with mRNA‐1273 (1.53 [1.01–2.27]) increased antibody concentrations, while anti‐TNF treatment (0.39 [0.28–0.54]) and prolonged time between vaccination and antibody measurement (0.72 [0.58–0.90]) decreased anti‐SARS‐CoV‐2 spike antibodies. Antibody decline was comparable in IBD patients independent of anti‐TNF treatment and antibody concentrations could not predict breakthrough infections. Cellular and humoral immune responses were uncoupled, and more anti‐TNF‐treated patients than healthy controls developed inadequate T cell responses (15/73 [20.5%] vs 2/100 [2.0%]; p = 0.00031). Conclusions: Anti‐TNF‐treated IBD patients have impaired humoral and cellular immunogenicity following SARS‐CoV‐2 booster vaccination. Fourth dose administration may be beneficial for these patients. Abstract : The humoral immune response and the T cell response to a third SARS‐CoV‐2 mRNA vaccination are reduced in anti‐TNF antibody‐treated IBD patients compared to healthy controls (graphical summary of the STAR SIGN study).