Long-Term Effectiveness and Durability of COVID-19 Vaccination Among Patients With Inflammatory Bowel Disease

Erica J Brenner; Kimberly N Weaver; Xian Zhang; Arthur J Kastl; Jennifer A Strople; Jeremy Adler; Marla C Dubinsky; Athos Bousvaros; Runa Watkins; Xiangfeng Dai; Wenli Chen; Raymond K Cross; Peter D R Higgins; Ryan C Ungaro; Meenakshi Bewtra; Emanuelle A Bellaguarda; Francis A Farraye; Kelly Y Chun; Michael Zikry; Monique Bastidas; Ann Firestine; Riley G Craig; Margie E Boccieri; Millie D Long; Michael D Kappelman

doi:10.1016/j.cgh.2024.02.001

Long-Term Effectiveness and Durability of COVID-19 Vaccination Among Patients With Inflammatory Bowel Disease

Clin Gastroenterol Hepatol. 2024 Feb 17:S1542-3565(24)00203-9. doi: 10.1016/j.cgh.2024.02.001. Online ahead of print.

Authors

Erica J Brenner¹, Kimberly N Weaver², Xian Zhang³, Arthur J Kastl⁴, Jennifer A Strople⁵, Jeremy Adler⁶, Marla C Dubinsky⁷, Athos Bousvaros⁸, Runa Watkins⁹, Xiangfeng Dai¹⁰, Wenli Chen¹⁰, Raymond K Cross¹¹, Peter D R Higgins¹², Ryan C Ungaro¹³, Meenakshi Bewtra¹⁴, Emanuelle A Bellaguarda¹⁵, Francis A Farraye¹⁶, Kelly Y Chun¹⁷, Michael Zikry¹⁷, Monique Bastidas¹⁷, Ann Firestine¹⁸, Riley G Craig¹⁹, Margie E Boccieri³, Millie D Long¹⁹, Michael D Kappelman³

Affiliations

¹ Division of Pediatric Gastroenterology, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Center for Gastrointestinal Biology and Disease, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina. Electronic address: erica.brenner@unchealth.unc.edu.
² Division of Gastroenterology, Hepatology, and Nutrition, Allegheny Health Network, Pittsburgh, Pennsylvania.
³ Division of Pediatric Gastroenterology, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Center for Gastrointestinal Biology and Disease, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
⁴ Division of Gastroenterology, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
⁵ Division of Pediatric Gastroenterology, Hepatology and Nutrition, Ann & Robert H. Lurie Children's Hospital of Chicago, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
⁶ Susan B. Meister Child Health Evaluation and Research Center, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan.
⁷ Dr. Henry D. Janowitz Division of Gastroenterology, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York.
⁸ Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
⁹ Division of Pediatric Gastroenterology and Nutrition, University of Maryland School of Medicine, Baltimore, Maryland.
¹⁰ Center for Gastrointestinal Biology and Disease, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
¹¹ Division of Gastroenterology and Hepatology, University of Maryland School of Medicine, Baltimore, Maryland.
¹² Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan.
¹³ Dr. Henry D. Janowitz Division of Gastroenterology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.
¹⁴ Division of Gastroenterology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania.
¹⁵ Division of Gastroenterology and Hepatology, Northwestern University, Chicago, Illinois.
¹⁶ Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida.
¹⁷ Research and Development, LabCorp, Calabasas, California.
¹⁸ Division of Pediatric Gastroenterology, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
¹⁹ Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Multidisciplinary Center for Inflammatory Bowel Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.

PMID: 38369224
DOI: 10.1016/j.cgh.2024.02.001

Abstract

Background and aims: COVID-19 vaccination prevents severe disease in most patients with inflammatory bowel disease (IBD), but immunosuppressive medications can blunt serologic response. We followed adults with IBD for >1 year post-COVID-19 vaccination to describe factors associated with SARS-CoV-2 infection after vaccination, evaluate for a protective SARS-CoV-2 antibody level, characterize SARS-CoV-2 antibody persistence, and identify factors associated with humoral immune response durability.

Methods: Using a prospective cohort of COVID-19 immunized adults with IBD, we analyzed factors associated with SARS-CoV-2 infection after vaccination. We evaluated for an association between SARS-CoV-2 antibody level 12 weeks postvaccination and subsequent SARS-CoV-2 infection and assessed for a threshold of protection using receiver-operating characteristic curve analysis. We then conducted a separate analysis evaluating factors associated with persistence of SARS-CoV-2 antibodies 52 weeks postimmunization.

Results: Almost half (43%) of 1869 participants developed COVID-19 after vaccination, but most infections were mild, and <1% required hospitalization. Older age and corticosteroid use were associated with a decreased risk of SARS-CoV-2 infection postvaccination (50-59 years of age vs 18-29 years of age: adjusted hazard ratio, 0.57; 95% confidence interval, 0.44-0.74; steroid users vs nonusers: adjusted hazard ratio, 0.58; 95% confidence interval, 0.39-0.87). Most (98%) participants had detectable antibody levels at 52 weeks postvaccination. Antibody levels at 12 weeks and number of vaccine doses were positively associated with higher antibody levels at 52 weeks, while anti-tumor necrosis factor α therapy was negatively associated.

Conclusions: COVID-19 vaccination generates an effective and durable protective response for the vast majority of adults with IBD, including vulnerable populations such as corticosteroid users and older individuals. Patients with IBD benefit from COVID-19 booster vaccination.

Keywords: COVID-19; Crohn’s Disease; Ulcerative Colitis; Vaccination.