Antibody decay, T cell immunity and breakthrough infections following two SARS-CoV-2 vaccine doses in inflammatory bowel disease patients treated with infliximab and vedolizumab.
Creators: name: Lin, Simeng
name: Kennedy, Nicholas A
name: Saifuddin, Aamir
name: Sandoval, Diana Muñoz
name: Reynolds, Catherine J
name: Seoane, Rocio Castro
name: Kottoor, Sherine H
name: Pieper, Franziska P
name: Lin, Kai-Min
name: Butler, David K
name: Chanchlani, Neil
name: Nice, Rachel
name: Chee, Desmond
name: Bewshea, Claire
name: Janjua, Malik
name: McDonald, Timothy J
name: Sebastian, Shaji
name: Alexander, James L
name: Constable, Laura
name: Lee, James C
name: Murray, Charles D
name: Hart, Ailsa L
name: Irving, Peter M
name: Jones, Gareth-Rhys
name: Kok, Klaartje B
name: Lamb, Christopher A
name: Lees, Charlie W
name: Altmann, Daniel M
name: Boyton, Rosemary J
name: Goodhand, James R
name: Powell, Nick
name: Ahmad, Tariq
name: CLARITY IBD Study
Publisher: name: Apollo - University of Cambridge Repository
Year: 2022
Subjects: Article
/631/250/590
/692/4020/1503/257
/631/250/2152/2153
/631/326/596/4130
article

description: Funder: Royal Devon and Exeter NHS Foundation Trust (Royal Devon &amp; Exeter NHS Foundation Trust); doi: https://doi.org/10.13039/100009745
description: Funder: Roche (F. Hoffmann-La Roche Ltd); doi: https://doi.org/10.13039/100004337
description: Funder: Celltrion Healthcare; doi: https://doi.org/10.13039/100010780
description: Funder: NIHR Imperial Biomedical Research Centre, Hull University Teaching Hospital NHS Trust, UKRI (MR/V036939/1), Biogen GmbH (Switzerland), Takeda (UK), and Galapagos NV (Belgium).
description: Anti tumour necrosis factor (anti-TNF) drugs increase the risk of serious respiratory infection and impair protective immunity following pneumococcal and influenza vaccination. Here we report SARS-CoV-2 vaccine-induced immune responses and breakthrough infections in patients with inflammatory bowel disease, who are treated either with the anti-TNF antibody, infliximab, or with vedolizumab targeting a gut-specific anti-integrin that does not impair systemic immunity. Geometric mean [SD] anti-S RBD antibody concentrations are lower and half-lives shorter in patients treated with infliximab than vedolizumab, following two doses of BNT162b2 (566.7 U/mL [6.2] vs 4555.3 U/mL [5.4], p &lt;0.0001; 26.8 days [95% CI 26.2 - 27.5] vs 47.6 days [45.5 - 49.8], p &lt;0.0001); similar results are also observed with ChAdOx1 nCoV-19 vaccination (184.7 U/mL [5.0] vs 784.0 U/mL [3.5], p &lt;0.0001; 35.9 days [34.9 - 36.8] vs 58.0 days [55.0 - 61.3], p value &lt; 0.0001). One fifth of patients fail to mount a T cell response in both treatment groups. Breakthrough SARS-CoV-2 infections are more frequent (5.8% (201/3441) vs 3.9% (66/1682), p = 0.0039) in patients treated with infliximab than vedolizumab, and the risk of breakthrough SARS-CoV-2 infection is predicted by peak anti-S RBD antibody concentration after two vaccine doses. Irrespective of the treatments, higher, more sustained antibody levels are observed in patients with a history of SARS-CoV-2 infection prior to vaccination. Our results thus suggest that adapted vaccination schedules may be required to induce immunity in at-risk, anti-TNF-treated patients.