Infliximab or tofacitinib for IBD associated with lower response to COVID-19 vaccination
An industry-funded study in England looked at SARS-CoV-2 antibody concentrations after two vaccine doses among patients taking infliximab, tofacitinib, thiopurine, ustekinumab, or vedolizumab for inflammatory bowel disease (IBD), comparing them to healthy controls.
Response to COVID-19 vaccination varies by which immunosuppressive drug a patient is taking, according to an industry-funded study of patients with inflammatory bowel disease (IBD).
The prospective study, funded by Pfizer, included 483 patients with IBD taking any of six different immunosuppressive treatment regimens and 121 controls in England. All received two doses of the Oxford-AstraZeneca, Pfizer-BioNTech, or Moderna COVID-19 vaccines, and antibody responses were measured 53 to 92 days after the second dose. A total of 370 participants without evidence of previous infection were included in the primary analysis. Results were published by The Lancet Gastroenterology & Hepatology on Feb. 3.
Some of the IBD treatments were associated with significantly lower geometric mean anti-SARS-CoV-2 spike protein antibody concentrations compared with controls (1,578.3 U/mL), including infliximab (156.8 U/mL; P<0.0001), infliximab plus thiopurine (111.1 U/mL; P<0.0001), and tofacitinib (429.5 U/mL; P=0.0012). On the other hand, there were no significant reductions in antibody concentrations compared to controls among patients treated with thiopurine monotherapy (1,019.8 U/mL; P=0.74), ustekinumab (582.4 U/mL; P=0.11), or vedolizumab (954.0 U/mL; P=0.50). In multivariable modeling, lower antibody concentrations were independently associated with infliximab and tofacitinib treatment, but not with ustekinumab, thiopurine, or vedolizumab treatment. The study also found that antibody responses were higher with receipt of an mRNA vaccine and lower with older patient age.
The study authors cautioned that the study was limited by its size, prohibiting definitive conclusions about the effects of some of the drugs, but they suggested that scheduling of third vaccine doses could be personalized on the basis of IBD treatment, with patients taking an anti-tumor necrosis factor (TNF) drug or tofacitinib prioritized for extra doses.
An accompanying editorial said that the study addressed an important knowledge gap but that other research has offered some more reassuring data. “Despite concerns surrounding the robustness of the immune response to vaccination among people being treated with anti-TNF therapies, these same patients do not seem to be at an increased risk of contracting COVID-19 compared with people with IBD not on biological therapy and the age-matched general population,” the editorialists wrote. They added that encouraging booster doses for such patients three to four months after initial vaccination is reasonable.