地理因素影响炎症性肠病患者对 SARS-CoV-2 血清学反应的易感性：来自 ICARUS-IBD 联盟的多国分析。

Geography Influences Susceptibility to SARS-CoV-2 Serological Response in Patients With Inflammatory Bowel Disease: Multinational Analysis From the ICARUS-IBD Consortium.

机构信息

Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.

Department of Gastroenterology and Hepatology, Leuven University Hospitals, Leuven, Belgium.

出版信息

Inflamm Bowel Dis. 2023 Nov 2;29(11):1693-1705. doi: 10.1093/ibd/izad097.

DOI:10.1093/ibd/izad097

PMID:37354560

Abstract

BACKGROUND

Beyond systematic reviews and meta-analyses, there have been no direct studies of serological response to COVID-19 in patients with inflammatory bowel disease (IBD) across continents. In particular, there has been limited data from Asia, with no data reported from India. The ICARUS-IBD (International study of COVID-19 Antibody Response Under Sustained immunosuppression in IBD) consortium assessed serological response to SARS-CoV-2 in patients with IBD in North America, Europe, and Asia.

METHODS

The ICARUS-IBD study is a multicenter observational cohort study spanning sites in 7 countries. We report seroprevalence data from 2303 patients with IBD before COVID-19 vaccination between May 2020 and November 2021. SARS-CoV-2 anti-spike and anti-nucleocapsid antibodies were analyzed.

RESULTS

The highest and lowest SARS-CoV-2 anti-spike seropositivity rates were found in Asia (81.2% in Chandigarh and 57.9% in Delhi, India; and 0% in Hong Kong). By multivariable analysis, country (India: odds ratio [OR], 18.01; 95% confidence interval [CI], 12.03-26.95; P < .0001; United Kingdom: OR, 2.43; 95% CI, 1.58-3.72; P < .0001; United States: OR, 2.21; 95% CI, 1.27-3.85; P = .005), male sex (OR, 1.46; 95% CI, 1.07-1.99; P = .016), and diabetes (OR, 2.37; 95% CI, 1.04-5.46; P = .039) conferred higher seropositivity rates. Biological therapies associated with lower seroprevalence (OR, 0.22; 95% CI, 0.15-0.33; P < .0001). Multiple linear regression showed associations between anti-spike and anti-nucleocapsid titers with medications (P < .0001) but not with country (P = .3841).

CONCLUSIONS

While the effects of medications on anti-SARS-CoV-2 antibody titers in patients with IBD were consistent across sites, geographical location conferred the highest risk of susceptibility to serologically detectable SARS-CoV-2 infection. Over half of IBD patients in India were seropositive prior to vaccination. These insights can help to inform shielding advice, therapeutic choices, and vaccine strategies in IBD patients for COVID-19 and future viral challenges.

摘要

背景

除了系统评价和荟萃分析之外，目前还没有针对不同大洲的炎症性肠病（IBD）患者对 COVID-19 的血清学反应的直接研究。特别是，亚洲的数据有限，印度没有报告相关数据。ICARUS-IBD（在 IBD 中持续免疫抑制下 COVID-19 抗体反应的国际研究）研究联合体评估了北美、欧洲和亚洲的 IBD 患者对 SARS-CoV-2 的血清学反应。

方法

ICARUS-IBD 研究是一项多中心观察性队列研究，跨越了 7 个国家的多个研究地点。我们报告了 2020 年 5 月至 2021 年 11 月期间在 COVID-19 疫苗接种前接受 IBD 治疗的 2303 名患者的血清学阳性率数据。分析了 SARS-CoV-2 抗刺突蛋白和抗核衣壳抗体。

结果

血清学阳性率最高的是亚洲（昌迪加尔为 81.2%，印度德里为 57.9%；香港为 0%）。通过多变量分析，国家（印度：比值比[OR]，18.01；95%置信区间[CI]，12.03-26.95；P<0.0001；英国：OR，2.43；95%CI，1.58-3.72；P<0.0001；美国：OR，2.21；95%CI，1.27-3.85；P=0.005）、男性（OR，1.46；95%CI，1.07-1.99；P=0.016）和糖尿病（OR，2.37；95%CI，1.04-5.46；P=0.039）与更高的血清学阳性率相关。与较低的血清阳性率相关的生物治疗（OR，0.22；95%CI，0.15-0.33；P<0.0001）。多元线性回归显示，抗刺突蛋白和抗核衣壳滴度与药物之间存在关联（P<0.0001），但与国家无关（P=0.3841）。

结论

虽然 IBD 患者药物对 SARS-CoV-2 抗体滴度的影响在各个研究地点是一致的，但地理位置是对血清学可检测到的 SARS-CoV-2 感染的最高易感性的决定因素。在接受疫苗接种之前，印度有超过一半的 IBD 患者呈血清阳性。这些发现可以帮助为 IBD 患者提供 COVID-19 和未来病毒挑战的防护建议、治疗选择和疫苗策略。