P0632 Analysis of serological responses to SARS-Cov-2 vaccination in patients with Inflammatory Bowel Disease in India identifies low BMI as an independent determinant of vaccine non-response
Authors: Wong S Y , Moran H R , Elgood-Hunt G , Stolle L , Giselbrecht E , Wellens J , Ahuja V , Virmani S , Kedia S , Dutta U , Sinha S K , Sharma V , Samanta J , Shah J , Singh A K , Kaur H , Colombel J F , Thompson C , Satsangi J 
Published: January 2025

Abstract

Background
Studies of patients with inflammatory bowel diseases (IBD) from Western countries have demonstrated that serological responses to mRNA and vector-based vaccines are differentially impacted by IBD therapies. Little is known regarding antibody responses in patients with IBD residing in low- and middle-income countries (1). In this study, we investigate the factors which may influence the inhibitory and total antibody responses to SARS-CoV-2 in two centers in Northern India.

Methods
We studied 180 IBD patients in Chandigarh and New Delhi, India, who received two doses of a COVID-19 vaccine. All patients received Oxford-AstraZeneca equivalent Covishield (n=149) or inactivated virus vaccine Covaxin (n=31) between January 2021 and December 2022. We measured anti-S and anti-N antibody levels and performed inhibition assays to measure the inhibition of ACE2 on SARS-CoV-2 binding against alpha, delta, and omicron variants after first and second vaccine doses. Univariate and multivariate analyses were performed to identify determinants of vaccine response.

Results
On univariate analysis, IBD patients taking steroids (p= 0.019), immunomodulators (p= 0.047), or infliximab (p= 0.0057) had lower responses after dose 2 for any vaccine compared to those not on these medications or receiving 5-ASAs.
Low BMI was associated with reduced rates of seroconversion in univariate analysis. For every fall in BMI by 1, the average ACOV2S V2 anti-Spike level was reduced by 8.2 (Figure 1). Additionally, 97% (28/29) of vaccinated IBD patients with a BMI greater than or equal to 25 reached the maximum anti-Spike value after their second dose of a COVID-19 vaccine.
Multivariate analysis comparing gender, IBD type, smoking status, comorbidities, IBD medications, and a history of COVID-19 diagnosis revealed that low BMI (dose 1: OR: 1.12 [CI: 0.084, 0.136]; dose 2: 1.11 [0.076, 0.128]), infliximab (dose 1: 1.67 [-.92, 1.94]), and patients on steroids (dose 1: 1.50 [-1.384, 2.195]; dose 2: 0.200 [-3.76 0.54]) were each independent determinants of lower seroprevalence levels after receiving a dose of Covishield or Covaxin.

Conclusion
Immunosuppressive drug therapy and reduced BMI emerge as determinants of sub-optimal seroconversion rate in this patient population. The association with low BMI represents a unique finding in this population, and directly contrast with studies reported in Europe & North America. These data are useful for future pandemic vaccine considerations in patients with IBD.

References
(1)Wong SY, Wellens J, Helmus D, et al. Geography Influences Susceptibility to SARS-CoV-2 Serological Response in Patients With Inflammatory Bowel Disease: Multinational Analysis From the ICARUS-IBD Consortium. Inflamm Bowel Dis. 2023;29(11):1693-1705. doi:10.1093/ibd/izad097