SARS-CoV-2 vaccination for patients with inflammatory bowel disease: a British Society of Gastroenterology Inflammatory Bowel Disease section and IBD Clinical Research Group position statement

Abstract

SARS-CoV-2 has caused a global health crisis and mass vaccination programmes provide the best opportunity for controlling transmission and protecting populations. Despite the impressive clinical trial results of the BNT162b2 (Pfizer/BioNTech), ChAdOx1 nCoV-19 (Oxford/AstraZeneca), and mRNA-1273 (Moderna) vaccines, important unanswered questions remain, especially in patients with pre-existing conditions. In this position statement endorsed by the British Society of Gastroenterology Inflammatory Bowel Disease (IBD) section and IBD Clinical Research Group, we consider SARS-CoV-2 vaccination strategy in patients with IBD. The risks of SARS-CoV-2 vaccination are anticipated to be very low, and we strongly support SARS-CoV-2 vaccination in patients with IBD.Based on data from previous studies with other vaccines, there are conceptual concerns that protective immune responses to SARS-CoV-2 vaccination may be diminished in some patients with IBD, such as those taking anti-TNF drugs. However, the benefits of vaccination, even in patients treated with anti-TNF drugs, are likely to outweigh these theoretical concerns. Key areas for further research are discussed, including vaccine hesitancy and its effect in the IBD community, the effect of immunosuppression on vaccine efficacy, and the search for predictive biomarkers of vaccine success.

Infliximab is associated with attenuated immunogenicity to BNT162b2 and ChAdOx1 nCoV-19 SARS-CoV-2 vaccines in patients with IBD

“…No adequately powered studies have reported the effect of anti-TNF drugs on vaccine responses. 17 Our findings are similar, however, to recent reports of the immunogenicity of the BNT162b2 and mRNA-1273 vaccines in transplant recipients and in patients with malignancy treated with antimetabolite immunosuppression, conventional chemotherapy or immune checkpoint inhibitors. 18 19 The authors showed fewer patients treated with potent immunosuppressants seroconverted than healthy controls.…”

How to Manage COVID-19 Vaccination in Immune-Mediated Inflammatory Diseases: An Expert Opinion by IMIDs Study Group

“…Instead, to increase the rate of immune response, a proper time of vaccination can be suggested according the ongoing treatment (Table 1) and/or a different vaccination protocol with repeated booster can be evaluated. Accordingly, the recent position statement from the British Society of Gastroenterology and IBD Clinical Research Group strongly recommends the vaccination in IBD patients, even if some concerns on the effectiveness of the immune response are raised (14).…”

SARS‐CoV‐2 (COVID‐19) vaccination in dermatology patients on immunomodulatory and biologic agents: Recommendations from the Australasian Medical Dermatology Group

“…a Anti-TNF agents have been associated with impaired vaccine efficacy for hepatitis B, hepatitis A, pneumococcal and influenza in inflammatory bowel disease, 10,11 although vaccination responses are relatively preserved when anti-TNF agents are used in rheumatoid arthritis. 12,13 b There is a consistent body of evidence that methotrexate impairs humoral response when used as monotherapy or in combination with a biologic.…”