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.

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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