Gastroenterology Department, Hospital Professor Doutor Fernando Fonseca, IC 19, 2720-276 Amadora, Portugal.
Gastroenterology Department, Hospital Professor Doutor Fernando Fonseca, IC 19, 2720-276 Amadora, Portugal.
Vaccine. 2023 Jun 13;41(26):3862-3871. doi: 10.1016/j.vaccine.2023.05.012. Epub 2023 May 8.
Immunosuppressive therapy used in the treatment of inflammatory bowel disease (IBD) is known to reduce vaccine immunogenicity.
This study aimed to 1) predict the humoral response elicited by SARS-CoV-2 vaccination in IBD patients based on their ongoing treatment and other relevant patient and vaccine characteristics and 2) assess the humoral response to a booster dose of mRNA vaccine.
We conducted a prospective study in adult IBD patients. Anti-spike (S) IgG antibodies were measured after initial vaccination and again after one booster dose. A multiple linear regression model was created to predict anti-S antibody titer following initial complete vaccination in different therapeutic groups (no immunosuppression, anti-TNF, immunomodulators and combination therapy). A two-tailed Wilcoxon test for two dependent groups was performed to compare anti-S values before and after the booster dose.
Our study included 198 IBD patients. The multiple linear regression identified anti-TNF and combination therapy (versus no immunosuppression), current smoking, viral vector (versus mRNA) vaccine and interval between vaccination and anti-S measurement as statistically significant predictors of the log anti-S antibody levels (p < 0.001). No statistically significant differences were found between no immunosuppression and immunomodulators (p = 0.349) and between anti-TNF and combination therapy (p = 0.997). Statistically significant differences for anti-S antibody titer before and after the booster dose of mRNA SARS-CoV-2 vaccine were found, both for non-anti-TNF and anti-TNF groups.
Anti-TNF treatment (either alone or in combination therapy) is associated with lower anti-S antibody levels. Booster mRNA doses seem to increase anti-S both in non-anti-TNF and anti-TNF treated patients. Special attention should be paid to this group of patients when planning vaccination schemes.
用于治疗炎症性肠病（IBD）的免疫抑制疗法已知会降低疫苗的免疫原性。
本研究旨在 1）根据正在进行的治疗以及其他相关患者和疫苗特征预测 IBD 患者接种 SARS-CoV-2 疫苗后的体液反应，2）评估 mRNA 疫苗加强剂量的体液反应。
我们进行了一项成人 IBD 患者的前瞻性研究。在初始接种后和再次接种一剂加强针后测量针对刺突（S）的 IgG 抗体。创建了一个多元线性回归模型，以预测不同治疗组（无免疫抑制、抗 TNF、免疫调节剂和联合治疗）在初始完全接种后的抗 S 抗体滴度。对两组进行双侧 Wilcoxon 检验，以比较加强剂量前后的抗 S 值。
我们的研究纳入了 198 名 IBD 患者。多元线性回归确定了抗 TNF 和联合治疗（与无免疫抑制相比）、当前吸烟、病毒载体（与 mRNA 疫苗相比）和疫苗接种与抗 S 测量之间的时间间隔是抗 S 抗体水平的统计学显著预测因子（p<0.001）。无免疫抑制和免疫调节剂（p=0.349）以及抗 TNF 和联合治疗（p=0.997）之间无统计学显著差异。在非抗 TNF 和抗 TNF 组中，mRNA SARS-CoV-2 疫苗加强剂量前后的抗 S 抗体滴度均存在统计学显著差异。
抗 TNF 治疗（单独或联合治疗）与较低的抗 S 抗体水平相关。mRNA 加强剂量似乎增加了非抗 TNF 和抗 TNF 治疗患者的抗 S。在规划疫苗接种方案时应特别关注这组患者。
