Gastroenterology Department, Hospital da Senhora da Oliveira, Guimarães, Portugal.
Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga, Portugal.
Inflamm Bowel Dis. 2023 Feb 1;29(2):268-273. doi: 10.1093/ibd/izac187.
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection may lead to the development of the novel coronavirus disease (coronavirus disease 2019 [COVID-19]). Scarce data are available regarding safety and efficacy of SARS-CoV-2 vaccination in inflammatory bowel disease (IBD) patients, which may present differences between subgroups. Lower humoral immunological response could require additional booster injections.
This is a prospective study including adult patients with IBD after complete vaccination against SARS-CoV-2 infection with BioNTech vaccine. Patients with previous SARS-CoV-2 infection were excluded. A control group with healthy individuals matched for age and sex was also analyzed. Blood samples were collected 30 days after complete vaccination to quantify immunoglobulin G (IgG) antibody titers against SARS-CoV-2 in both groups.
The final sample included 81 IBD and 32 non-IBD patients, 55 (48.7%) of them women, with a mean age of 40.2 ± 13.0 years. From IBD patients, 58 (71.6%) had Crohn's disease and 23 (28.4%) had ulcerative colitis. IBD patients had significantly lower median anti-SARS-CoV-2 IgG levels when compared with the control group (6479 [interquartile range (IQR) 1830-11883, 10 053] AU/mL vs 13 061 [IQR 2826-21427, 15 539] AU/mL; P = .003). Regarding IBD medication, significant lower levels of SARS-CoV-2 IgG antibodies when compared with control subjects were observed in patients treated with thiopurines (5423 [IQR 3109-13369, 10 260] AU/mL; P = .011), methotrexate (834 [IQR 507-3467, 4155] AU/mL; P = .002), anti-tumor necrosis factor α agents (5065 [IQR 1033-11669, 10 636] AU/mL; P = .001), and corticosteroids (548 AU/mL; P = .001). The incidence of SARS-CoV-2 infection after vaccination was also significantly higher in patients treated with these agents.
IBD patients treated with immunomodulators, anti-tumor necrosis factor α agents and corticosteroids presented significantly lower anti-SARS-CoV-2 IgG levels following complete vaccination when compared with healthy control subjects. These findings support the benefit of additional booster injections in this population.
严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）感染可能导致新型冠状病毒病（COVID-19）的发生。炎性肠病（IBD）患者接种 SARS-CoV-2 疫苗的安全性和有效性的数据很少，这可能在亚组之间存在差异。较低的体液免疫反应可能需要额外的加强注射。
这是一项前瞻性研究，纳入了已完成 BioNTech 疫苗接种的 IBD 成年患者。排除了有 SARS-CoV-2 既往感染的患者。还分析了一组与年龄和性别相匹配的健康个体作为对照组。两组均在完成疫苗接种 30 天后采集血样，以定量检测 SARS-CoV-2 免疫球蛋白 G（IgG）抗体滴度。
最终样本纳入 81 例 IBD 患者和 32 例非 IBD 患者，其中 55 例（48.7%）为女性，平均年龄为 40.2±13.0 岁。IBD 患者中，58 例（71.6%）为克罗恩病，23 例（28.4%）为溃疡性结肠炎。与对照组相比，IBD 患者的 SARS-CoV-2 IgG 水平中位数明显较低（6479[四分位距（IQR）1830-11883，10053]AU/mL 比 13061[IQR 2826-21427，15539]AU/mL；P=.003）。在 IBD 药物方面，与对照组相比，接受硫嘌呤（5423[IQR 3109-13369，10260]AU/mL；P=.011）、甲氨蝶呤（834[IQR 507-3467，4155]AU/mL；P=.002）、抗肿瘤坏死因子α（5065[IQR 1033-11669，10636]AU/mL；P=.001）和皮质类固醇（548AU/mL；P=.001）治疗的患者 SARS-CoV-2 IgG 抗体水平明显较低。接种疫苗后 SARS-CoV-2 感染的发生率也明显更高。
与健康对照组相比，接受免疫调节剂、抗肿瘤坏死因子α药物和皮质类固醇治疗的 IBD 患者在完成疫苗接种后 SARS-CoV-2 IgG 水平明显较低。这些发现支持在该人群中进行额外加强注射的益处。
