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Most physicians who treat people with inflammatory bowel disease (IBD) agree that such patients should be vaccinated against COVID-19, but questions remain about how effective the vaccines may be in this group. The reason: many IBD patients take medications that affect immune system function, such as biologic treatments, to suppress the hyper-immune response in their gut. This may prevent them from mounting the same immune response as otherwise healthy people to the COVID-19 vaccine, but no one knows for sure because studies in this area are currently underway.
Fortunately, a small new study suggests that such concern may be unwarranted.
The research, which appears in the journal Gastroenterology, evaluated 48 people with Crohn’s disease or ulcerative colitis (both are considered forms of inflammatory bowel disease). Two control groups comprised of 14 health care workers and 29 healthy volunteers were also included in the study.
Everyone in the study received at least one dose of a two-dose mRNA COVID vaccine (Pfizer or Moderna). All the control subjects and 26 of the IBD patients completed both doses.
Study participants had their blood drawn to measure antibody response to vaccination. Several types of antibodies, including total immunoglobulins (Ig) and antibodies to the receptor binding domain (RBD, which is where the SARS-Co-V2 virus attaches to cells), were measured.
According to the findings, all of the IBD patients who received two doses of the COVID vaccine had a positive anti-RBD test. In fact, 22 out of the 26 had a high-enough level of antibodies that they would be eligible as plasma donors in a convalescent plasma donation program. (Convalescent plasma entails infusing plasma from recovered COVID survivors into those currently battling the disease.) This suggests that they had achieved a very high level of protection.
There were a few IBD patients in the study who had previously contracted COVID; the researchers found that those individuals mounted a significant immune response after just one dose of the vaccine.
The control subjects all mounted an appropriate immune response to vaccination.
Although everyone in the study produced enough antibodies to suggest they would be protected against COVID-19, the researchers found that IBD patients who were taking the medication vedolizumab (Entyvio) had a somewhat lower immune response overall. Patients using a TNF inhibitor had a slightly lower level of RBD antibodies only, compared to the control group. TNF inhibitor biologics approved for IBD include adalimumab (Humira), certolizumab pegol (Cimzia), golimumab (Simponi), and infliximab (Remicade).
“This finding warrants further investigation, as results could have been affected by timing, vaccine, or clinical characteristics such as age,” the authors wrote.
Overall, the results are good news for people with IBD.
“Despite its limitations such as small sample size, single center experience, and differences in time to blood collections, this study brings a reassuring message to IBD patients and health care practitioners,” the authors wrote.
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Wong SY, et al. Serological response to mRNA COVID-19 vaccines in IBD patients receiving biological therapies. Gastroenterology. April 19, 2021. doi: https://doi.org/10.1053/j.gastro.2021.04.025.
