https://gastroenterology.acponline.org/archives/2021/10/22/5.htm

Spotlight on COVID-19 vaccines in IBD

Recent research looked at the response to mRNA COVID-19 vaccines among patients with inflammatory bowel disease (IBD), as well as examined COVID-19 vaccine uptake and offered ways to address vaccine hesitancy in this population.


COVID-19 vaccination in patients with inflammatory bowel disease (IBD) was the focus of several publications in the past month.

The first study, a meta-analysis of 25 observational studies including 5,360 patients, found that patients with immune-mediated inflammatory diseases, including IBD, have a reduced response to both doses of mRNA COVID-19 vaccines. Results were published online on Sept. 29 by Gastroenterology. Most studies used mRNA vaccines, and a small number of them included other types of vaccines (e.g., adenoviral, inactivated). Serologic responses after a single dose (six studies) and two doses (17 studies) of mRNA vaccine were 73.2% (95% CI, 65.7% to 79.5%) and 83.4% (95% CI, 76.8% to 88.4%), respectively. Compared to controls, patients with immune-mediated inflammatory diseases were less likely to achieve a serologic response after two doses of mRNA vaccine (six studies; odds ratio, 0.086 [95% CI, 0.036 to 0.206]; P<0.001). On meta-regression, anti-CD20 therapy was associated with lower response rates (P<0.001), and anti-tumor necrosis factor (TNF) therapy also showed a trend toward lower response rates (P=0.058).

There were not enough studies to assess response to the adenoviral or inactivated vaccines. Other limitations included heterogeneity among studies regarding sample size, type of immune-mediated inflammatory diseases, medication use, and type of and timing of antibody testing, the authors noted. “The results of our study suggest that patients with [immune-mediated inflammatory diseases] should receive the series of mRNA vaccines without delay and be considered for the 3rd dose of the vaccination,” they concluded. “Further studies assessing the response to different types of vaccines is warranted.”

Another study that looked at antibody responses after mRNA COVID-19 vaccination in adults with IBD found that initial humoral responses to mRNA vaccines are generally robust, even among those on biologic and small-molecule therapies. Results were published as a brief research report online on Oct. 12 by Annals of Internal Medicine. Researchers looked at 582 patients with IBD (mean age, 44 years; 55% women) who were referred from 18 U.S. gastroenterology practices and a social media campaign from January to July 2021 and who completed baseline surveys detailing medical history at the time of vaccination. Three hundred forty-two (59%) received the Pfizer-BioNTech vaccine, and 240 (41%) received the Moderna vaccine. Overall, 49% of participants had positive levels of antibodies after the first dose, 92% after the second dose, and 99% after week two, regardless of medication regimen. At eight weeks, mean quantitative antibody levels were highest in those with no immunosuppression, as well as in those treated with anti-integrin and anti-interleukin-12/23, and were lowest among those treated with anti-TNF combination therapy or corticosteroids; however, the study was not powered to assess differences across medication subgroups.

Limitations of the study include a lack of racial diversity and a tertiary center focus that may diminish generalizability, the authors noted. “Further characterization of immunity over time may inform future vaccination strategies for patients with IBD receiving biologic and small-molecule therapies,” they concluded.

Uptake of the COVID-19 vaccines appears to be high among certain patients with IBD, according to correspondence published online on Oct. 13 by The Lancet Gastroenterology & Hepatology. Researchers assessed vaccine uptake in 461 consecutive patients with IBD regularly attending the infusion center at one Oxford, U.K., hospital for maintenance infliximab or vedolizumab infusions between April 2020 and January 2021. The overall uptake of at least one vaccine dose was 96.5% (n=445), and 95.0% (n=438) were fully vaccinated, surpassing the general population vaccination rates of 79.4% in Oxfordshire and 88.2% nationwide. All patients older than age 60 years were vaccinated. Eleven of 16 patients who formally declined vaccination were women, five of whom were pregnant, in the postpartum period, or planning pregnancy.

Among other limitations, most patients with IBD in Oxfordshire are White British and live in relative affluence, restricting the generalizability of the findings, the authors noted. Their analysis “shows a very high vaccination uptake and highlights a potential for vaccine hesitancy in female patients of childbearing age with inflammatory bowel disease,” they concluded. “Larger studies in diverse patient populations are needed to assess if these findings can be extrapolated more widely.”

Finally, an invited commentary, published online on Sept. 24 by Inflammatory Bowel Diseases, offered ways to address COVID-19 vaccine hesitancy in patients with IBD. As the benefits of immunization outweigh the potential for a suboptimal response, COVID-19 vaccination is strongly recommended for all patients with IBD, the commentary noted. Clinicians who care for patients with IBD should assume the role of COVID-19 vaccine advocates in routine clinic visits, tailoring their approach to patients' needs and concerns and displaying cultural sensitivity, according to the commentary. In addition, resources such as pharmacists, nursing staff, and electronic messaging systems can help engage patients and lead to a more productive conversation.

To educate their patients with IBD and identify their concerns, the commentary authors developed an educational COVID-19 vaccine video of a gastroenterologist discussing the rationale for and efficacy and safety of the vaccines, specifically for patients with IBD. Of 45 patients who responded to a survey about the video, 43 answered that they were “absolutely certain” or “very likely” to receive a COVID-19 vaccine. In addition, 35 of 45 responded that the video was “very helpful” or “somewhat helpful” in making an informed decision regarding COVID-19 vaccination. “Based on our results, we suggest that providing tailored education content in the form of a video may be a valuable tool in decreasing vaccine hesitancy in patients with IBD and potentially in those with other chronic conditions,” the authors concluded. “In addition to increasing vaccination knowledge and awareness, other proposed methods include improving convenience and access to vaccination, targeting specific populations, and engaging influential persons to promote vaccination.”