Immunosuppressed Patients With IBD May Require More COVID-19 Vaccine Booster Doses

Patients with IBD who received treatment with infliximab or tofacitinib had a significantly reduced immune response after a third COVID-19 vaccine dose.

Immunosuppressed patients with inflammatory bowel disease (IBD) taking infliximab, infliximab plus thiopurine, and tofacitinib demonstrated lower antibody concentrations to the COVID-19 spike protein compared with healthy controls. Patients receiving treatment with tofacitinib also had reduced T-cell responses, according to study findings published in the Lancet Gastroenterology & Hepatology.

Researchers conducted a multicenter, prospective, case-control study in the United Kingdom from October 18, 2021 and March 29, 2022. They compared COVID-19 vaccine immune responses after the third dose in 280 immunosuppressed patients with Crohn disease, ulcerative colitis, or unclassified IBD with the responses of 72 nonimmunosuppressed, healthy individuals.

The patients with IBD were immunosuppressed from taking anti-tumor necrosis factor (TNF) medications, such as thiopurine (n=65), infliximab (n=46), thiopurine combined with infliximab (n=49), ustekinumab (n=44), vedolizumab (n=50), or tofacitinib (n=26).

Researchers analyzed anti-SARS-CoV-2 spike (S1 receptor binding domain) antibody concentrations and antigen-specific T-cell responses, suggestive of immune response to the third vaccine dose.

These findings support continued prioritization of immunosuppressed groups for further vaccine booster dosing, particularly patients on anti-TNF and JAK inhibitors.

Antibodies against the COVID-19 spike proteins increased in all study participants after the third vaccine; however, the antibody concentrations were significantly lower in patients receiving immunosuppressive treatments with infliximab (2736.8±4.3 U/mL; P <.0001), infliximab plus thiopurine (1818.3 6.7 U/mL; P <.0001), and tofacitinib (8071.5±3.1 U/mL; P =.0018) compared with the control group (16,774.2±2.6 U/mL).

In contrast, researchers did not observe any significant difference in antibody concentrations between the control group and patients with IBD treated with thiopurine (12,019.7±2.2 U/mL; P =.099), ustekinumab (11,089.3±2.8 U/mL; P =.060), or vedolizumab (13,564.9±2.4 U/mL; P =.27).

Compared with the control group, only COVID-19 infection-naïve individuals with IBD receiving tofacitinib treatment demonstrated significantly lower T-cell responses (P =.021) after the third vaccine dose.

“These findings support continued prioritization of immunosuppressed groups for further vaccine booster dosing, particularly patients on anti-TNF and JAK inhibitors,” the study authors said.

Study limitations include small tofacitinib sample size, using a method of selecting confounders that introduced the possibility of measurement bias or residual confounding due to measurement error, lack of data on biochemical or endoscopic disease activity, and the possibility of varying immune responses to different COVID-19 viral variants.

Disclosures: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

References:

Alexander JL, Liu Z, Muñoz Sandoval D, et al. COVID-19 vaccine-induced antibody and T-cell responses in immunosuppressed patients with inflammatory bowel disease after the third vaccine dose (VIP): a multicentre, prospective, case-control study. Lancet Gastroenterol Hepatol. 2022;7(11):1005-1015. doi:10.1016/S2468-1253(22)00274-6