Anti-SARS-CoV-2 Antibody Responses Attenuated in Patients Treated with Infliximab

Illustration of antibodies (y-shaped) responding to an infection with the new coronavirus SARS-CoV-2 (round). The virus emerged in Wuhan, China, in December 2019, and causes a mild respiratory illness (covid-19) that can develop into pneumonia and be fatal in some cases. The coronaviruses take their name from their crown (corona) of surface proteins, which are used to attach and penetrate their host cells. Once inside the cells, the particles use the cells’ machinery to make more copies of the virus. Antibodies bind to specific antigens, for instance viral proteins, marking them for destruction by other immune cells.
Researchers investigated whether infliximab-treated patients with inflammatory bowel disease have attenuated serological responses to SARS-CoV-2 infections.

Infliximab therapy is associated with an attenuated serological responses to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection that can be further blunted by immunomodulators, which may have important implications for patients treated with anti-tumor necrosis factors (anti-TNFs), according to a study published in Gut.

Anti-TNF therapies are effective treatments for immune-mediated inflammatory diseases. However, they can impair vaccine effectiveness and increase the risk of serious respiratory infections. Therefore, researchers sought to determine whether infliximab-treated patients with inflammatory bowel disease (IBD) have attenuated serological responses to SARS-CoV-2 infections. Researchers compared these patients 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 (ISRCTN Registration Number: ISRCTN45176516).

A total of 6935 patients were recruited from 92 hospitals in the United Kingdom between September 22, 2020 and December 23, 2020. Rates of symptomatic and proven SARS-CoV-2 infection were similar between the 2 groups. Seroprevalence was found to be lower in infliximab-treated patients than in vedolizumab-treated patients (3.4% [161/4685] vs 6.0% [134/2250]; P <.0001). In addition, multivariable logistic regression analyses confirmed that infliximab (vs vedolizumab; P =.0027) and immunomodulator use (P =.012) were independently associated with lower seropositivity.

In patients with confirmed SARS-CoV-2 infection, seroconversion was observed in fewer infliximab-treated patients than in vedolizumab-treated patients (48% [39/81] vs 83% [30/36]; P =.00044), and the magnitude of anti-SARS-CoV-2 reactivity was lower (P <.0001).

The authors concluded, “Impaired serological responses to SARS-CoV-2 infection might have important implications for global public health policy and millions of anti-TNF treated patients.” They added, “Serological testing and virus surveillance should be considered to detect suboptimal vaccine responses, persistent infection and viral evolution to inform public health policy.”

Disclosure: This clinical trial was supported by F. Hoffmann-La Roche, Hull University Teaching Hospital NHS Trust, Biogen GmbH (Switzerland), Celltrion Healthcare, Galapagos NV, Royal Devon, and Exeter NHS Foundation Trust. Please see the original reference for a full list of authors’ disclosures.  


Kennedy NA, Goodhand JR, Bewshea C, et al. Anti-SARS-CoV-2 antibody responses are attenuated in patients with IBD treated with infliximab. Gut. Published online February 18, 2021. DOI:10.1136/gutjnl-2021-324388