Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
IBD Unit, Hull University Teaching Hospitals NHS Trust, Hull, United Kingdom.
Clin Gastroenterol Hepatol. 2022 Jul;20(7):1456-1479.e18. doi: 10.1016/j.cgh.2022.02.030. Epub 2022 Feb 19.
The serological responses after severe acute respiratory syndrome coronavirus 2 vaccination may be attenuated in immunocompromised individuals. The study aimed to systematically evaluate the seroconversion rates after complete vaccination for coronavirus disease 2019 (COVID-19) in patients with inflammatory bowel disease (IBD).
Electronic databases were searched to identify studies reporting response to COVID-19 vaccination in IBD. Pooled seroconversion rates after complete vaccination were calculated. Subgroup analysis for vaccine types was also performed. Pooled seroconversion rates for various drugs or classes were also estimated. The pooled rates of breakthrough infections in vaccinated IBD patients were estimated. The pooled neutralization rates after complete vaccination were also estimated. The studies reporting durability of titers were systematically assessed.
A total of 46 studies were included. The pooled seroconversion rate for complete vaccination (31 studies, 9447 patients) was 0.96 (95% confidence interval [CI], 0.94-0.97; I = 90%). When compared with healthy control subjects, the pooled relative risk of seroconversion was lower (0.98; 95% CI, 0.98-0.99; I = 39%). The pooled seroconversion rates were statistically similar among various drug classes. The pooled positivity of neutralization assays (8 studies, 771 participants) was 0.80 (95% CI, 0.70-0.87; I = 82%). The pooled relative risk of breakthrough infections in vaccinated IBD patients was similar to vaccinated control subjects (0.60; 95% CI, 0.25-1.42; I = 79%). Most studies suggested that titers fall after 4 weeks of COVID-19 vaccination, and the decay was higher in patients on anti-tumor necrosis factor alone or combination with immunomodulators. An additional dose of COVID-19 vaccine elicited serological response in most nonresponders to complete vaccination.
Complete COVID-19 vaccination is associated with seroconversion in most patients with IBD. The decay in titers over time necessitates consideration of additional doses in these patients.
严重急性呼吸综合征冠状病毒 2 疫苗接种后的血清学反应在免疫功能低下的个体中可能减弱。本研究旨在系统评估炎症性肠病（IBD）患者完全接种新冠肺炎（COVID-19）疫苗后的血清转化率。
电子数据库检索报告 IBD 患者 COVID-19 疫苗接种反应的研究。计算完全接种疫苗后的血清转化率。还进行了疫苗类型的亚组分析。还估计了各种药物或类别的血清转化率。估计接种 IBD 患者突破性感染的发生率。还估计了完全接种疫苗后的中和率。系统评估了报告滴度持久性的研究。
共纳入 46 项研究。完全接种疫苗（31 项研究，9447 例患者）的血清转化率为 0.96（95%置信区间[CI]，0.94-0.97；I=90%）。与健康对照组相比，血清转化率的相对风险较低（0.98；95%CI，0.98-0.99；I=39%）。各种药物类别之间的血清转化率无统计学差异。中和试验的阳性率（8 项研究，771 例参与者）为 0.80（95%CI，0.70-0.87；I=82%）。接种 IBD 患者的突破性感染的相对风险与接种对照受试者相似（0.60；95%CI，0.25-1.42；I=79%）。大多数研究表明，COVID-19 疫苗接种后 4 周内滴度下降，单独使用抗肿瘤坏死因子或联合免疫调节剂的患者下降更高。COVID-19 疫苗的额外剂量可使大多数对完全接种疫苗无反应的患者产生血清学反应。
IBD 患者的 COVID-19 疫苗完全接种与血清转化有关。随着时间的推移，抗体滴度下降，这些患者需要考虑额外剂量。
