COVID-19 vaccination in IBD patients

July 19, 2022

Issue 14

Clinical Question

Are COVID-19 vaccines as effective in IBD patients?

Editor’s Bottom Line

Two doses of COVID-19 vaccine are effective for most patients with IBD, but antibody titers can decline and a third dose will seroconvert initial non-responders.

Reference

Jena A, James D, Singh AK, et al. Effectiveness and Durability of COVID-19 Vaccination in 9447 Patients With IBD: A Systematic Review and Meta-Analysis. Clin Gastroenterol Hepatol. 2022 Jul;20(7):1456–79.e18. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8856753/

Synopsis

This meta-analysis included 46 studies that documented response rates in IBD patients and individuals without IBD who had been fully vaccinated against COVID-19. The authors calculated pooled seroconversion rates, neutralization rates and pooled rates of breakthrough infections.

Data from 9,447 IBD patients who were fully vaccinated showed a 96% pooled seroconversion rate (95% Confidence Interval [CI], 0.94–0.97). When the authors looked at the specific type of COVID-19 vaccine, they found a pooled seroconversion rate of 97% among those receiving an mRNA vaccine (95% CI, 0.96–0.98) and a pooled seroconversion rate of 87% (95% CI, 0.78–0.93) among those who received a viral vector-based vaccine.

Data from 771 fully vaccinated individuals with IBD who underwent neutralization assay testing showed a pooled positivity rate of 80% (95% CI, 0.7–0.87), which was 15% lower than the pooled positivity rate among vaccinated individuals without IBD (Relative Risk [RR], 0.85; 95% CI, 0.75–0.96). The pooled relative risk of experiencing breakthrough infections in 36,207 vaccinated IBD patients was not statistically lower than the risk of breakthrough infections in vaccinated individuals without IBD. According to the authors, most of the data indicated that antibody titers declined four weeks after complete vaccination and those receiving an anti-TNF agent either alone or with an immunosuppressive medication experienced the greatest titer declines. Providing an additional vaccine dose led to a serological response in most individuals with IBD who did not experience seroconversion with initial complete vaccination.

Details

Study Design: Systematic review and meta-analysis

Funding: Not stated

Allocation: Not applicable

Setting: Multicenter

Level of Evidence: 2a