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Infliximab is associated with attenuated immunogenicity to BNT162b2 and ChAdOx1 nCoV-19 SARS-CoV-2 vaccines in patients with IBD

Kennedy, NA; Lin, S; Goodhand, JR; Chanchlani, N; Hamilton, B; Bewshea, C; Nice, R; Chee, D; Cummings, JRF; Fraser, A; et al. Kennedy, NA; Lin, S; Goodhand, JR; Chanchlani, N; Hamilton, B; Bewshea, C; Nice, R; Chee, D; Cummings, JRF; Fraser, A; Irving, PM; Kamperidis, N; Kok, KB; Lamb, CA; Macdonald, J; Mehta, S; Pollok, RCG; Raine, T; Smith, PJ; Verma, AM; Jochum, S; McDonald, TJ; Sebastian, S; Lees, CW; Powell, N; Ahmad, T; Contributors to the CLARITY IBD study (2021) Infliximab is associated with attenuated immunogenicity to BNT162b2 and ChAdOx1 nCoV-19 SARS-CoV-2 vaccines in patients with IBD. GUT, 70 (10). pp. 1884-1893. ISSN 0017-5749 https://doi.org/10.1136/gutjnl-2021-324789
SGUL Authors: Pollok, Richard Charles G

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Abstract

Objective Delayed second dose SARS-CoV-2 vaccination trades maximal effectiveness for a lower level of immunity across more of the population. We investigated whether patients with inflammatory bowel disease treated with infliximab have attenuated serological responses to a single dose of a SARS-CoV-2 vaccine. Design Antibody responses and seroconversion rates in infliximab-treated patients (n=865) were compared with a cohort treated with vedolizumab (n=428), a gut-selective anti-integrin α4β7 monoclonal antibody. Our primary outcome was anti-SARS-CoV-2 spike (S) antibody concentrations, measured using the Elecsys anti-SARS-CoV-2 spike (S) antibody assay 3–10 weeks after vaccination, in patients without evidence of prior infection. Secondary outcomes were seroconversion rates (defined by a cut-off of 15 U/mL), and antibody responses following past infection or a second dose of the BNT162b2 vaccine. Results Geometric mean (SD) anti-SARS-CoV-2 antibody concentrations were lower in patients treated with infliximab than vedolizumab, following BNT162b2 (6.0 U/mL (5.9) vs 28.8 U/mL (5.4) p<0.0001) and ChAdOx1 nCoV-19 (4.7 U/mL (4.9)) vs 13.8 U/mL (5.9) p<0.0001) vaccines. In our multivariable models, antibody concentrations were lower in infliximab-treated compared with vedolizumab-treated patients who received the BNT162b2 (fold change (FC) 0.29 (95% CI 0.21 to 0.40), p<0.0001) and ChAdOx1 nCoV-19 (FC 0.39 (95% CI 0.30 to 0.51), p<0.0001) vaccines. In both models, age ≥60 years, immunomodulator use, Crohn’s disease and smoking were associated with lower, while non-white ethnicity was associated with higher, anti-SARS-CoV-2 antibody concentrations. Seroconversion rates after a single dose of either vaccine were higher in patients with prior SARS-CoV-2 infection and after two doses of BNT162b2 vaccine. Conclusion Infliximab is associated with attenuated immunogenicity to a single dose of the BNT162b2 and ChAdOx1 nCoV-19 SARS-CoV-2 vaccines. Vaccination after SARS-CoV-2 infection, or a second dose of vaccine, led to seroconversion in most patients. Delayed second dosing should be avoided in patients treated with infliximab.

Item Type: Article
Additional Information: This article has been accepted for publication in Gut, 2021 following peer review, and the Version of Record can be accessed online at http://dx.doi.org/10.1136/gutjnl-2021-324789. © Author(s) (or their employer(s)) 2021.
Keywords: 1103 Clinical Sciences, 1114 Paediatrics and Reproductive Medicine, Gastroenterology & Hepatology
SGUL Research Institute / Research Centre: Academic Structure > Infection and Immunity Research Institute (INII)
Journal or Publication Title: GUT
ISSN: 0017-5749
Dates:
DateEvent
8 September 2021Published
26 April 2021Published Online
10 April 2021Accepted
Publisher License: Publisher's own licence
URI: https://openaccess.sgul.ac.uk/id/eprint/113201
Publisher's version: https://doi.org/10.1136/gutjnl-2021-324789

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