Infliximab is associated with attenuated immunogenicity to BNT162b2 and ChAdOx1 nCoV-19 SARS-CoV-2 vaccines in patients with IBD. Issue 10 (26th April 2021)

• Record Type: Journal Article
• Authors: Kennedy, Nicholas A; Lin, Simeng; Goodhand, James R; Chanchlani, Neil; Hamilton, Benjamin; Bewshea, Claire; Nice, Rachel; Chee, Desmond; Cummings, JR Fraser; Fraser, Aileen; Irving, Peter M; Kamperidis, Nikolaos; Kok, Klaartje B; Lamb, Christopher Andrew; Macdonald, Jonathan; Mehta, Shameer; Pollok, Richard CG; Raine, Tim; Smith, Philip J; Verma, Ajay Mark; Jochum, Simon; McDonald, Timothy J; Sebastian, Shaji; Lees, Charlie W; Powell, Nick; Ahmad, Tariq
• Is Part Of: Gut. Volume 70:Issue 10(2021)
• Page Start: 1884
• Page End: 1893
• Publication Date: 2021-04-26
• Subjects: infliximab -- inflammatory bowel disease -- TNF -- COVID-19 -- autoimmune disease -- inflammatory diseases -- CLARITY -- vedolizumab -- vaccine -- ChAdOx1 nCoV-19 -- BNT162b2; Gastroenterology -- Periodicals; 616.33
• DOI: 10.1136/gutjnl-2021-324789
• Languages: English
• ISSNs: 0017-5749

Abstract

Abstract : Objective: Delayed second dose SARS-CoV-2 vaccination trades maximal effectiveness for a lower level of immunity across more of the population. We investigated whether patients with inflammatory bowel disease treated with infliximab have attenuated serological responses to a single dose of a SARS-CoV-2 vaccine. Design: Antibody responses and seroconversion rates in infliximab-treated patients (n=865) were compared with a cohort treated with vedolizumab (n=428), a gut-selective anti-integrin α4β7 monoclonal antibody. Our primary outcome was anti-SARS-CoV-2 spike (S) antibody concentrations, measured using the Elecsys anti-SARS-CoV-2 spike (S) antibody assay 3–10 weeks after vaccination, in patients without evidence of prior infection. Secondary outcomes were seroconversion rates (defined by a cut-off of 15 U/mL), and antibody responses following past infection or a second dose of the BNT162b2 vaccine. Results: Geometric mean (SD) anti-SARS-CoV-2 antibody concentrations were lower in patients treated with infliximab than vedolizumab, following BNT162b2 (6.0 U/mL (5.9) vs 28.8 U/mL (5.4) p<0.0001) and ChAdOx1 nCoV-19 (4.7 U/mL (4.9)) vs 13.8 U/mL (5.9) p<0.0001) vaccines. In our multivariable models, antibody concentrations were lower in infliximab-treated compared with vedolizumab-treated patients who received the BNT162b2 (fold change (FC) 0.29 (95% CI 0.21 to 0.40), p<0.0001) and ChAdOx1 nCoV-19 (FC 0.39 (95% CI 0.30 to 0.51), p<0.0001) vaccines. In both models, age ≥60 years, immunomodulator use, Crohn's disease and smoking were associated with lower, while non-white ethnicity was associated with higher, anti-SARS-CoV-2 antibody concentrations. Seroconversion rates after a single dose of either vaccine were higher in patients with prior SARS-CoV-2 infection and after two doses of BNT162b2 vaccine. Conclusion: Infliximab is associated with attenuated immunogenicity to a single dose of the BNT162b2 and ChAdOx1 nCoV-19 SARS-CoV-2 vaccines. Vaccination after SARS-CoV-2 infection, or a second dose of vaccine, led to seroconversion in most patients. Delayed second dosing should be avoided in patients treated with infliximab. Trial registration number: ISRCTN45176516 .