Humoral Immunity in Immunosuppressed IBD Patients after the Third SARS-CoV-2 Vaccination: A Comparison with Healthy Control Subjects

Richard Vollenberg; Eva Ulla Lorentzen; Joachim Kühn; Tobias Max Nowacki; Jörn Arne Meier; Jonel Trebicka; Phil-Robin Tepasse

doi:10.3390/vaccines11091411

Humoral Immunity in Immunosuppressed IBD Patients after the Third SARS-CoV-2 Vaccination: A Comparison with Healthy Control Subjects

Vaccines (Basel). 2023 Aug 24;11(9):1411. doi: 10.3390/vaccines11091411.

Authors

Richard Vollenberg¹, Eva Ulla Lorentzen², Joachim Kühn², Tobias Max Nowacki³, Jörn Arne Meier¹, Jonel Trebicka¹, Phil-Robin Tepasse¹

Affiliations

¹ Department of Medicine B for Gastroenterology, Hepatology, Endocrinology and Clincial Infectiology, University Hospital Muenster, 48149 Muenster, Germany.
² Institute of Virology, University Hospital Muenster, 48149 Muenster, Germany.
³ Department of Medicine, Gastroenterology, Marienhospital Steinfurt, 48565 Steinfurt, Germany.

Abstract

Introduction: The COVID-19 pandemic is a result of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Vaccination against COVID-19 is crucial for preventing severe illness and controlling the pandemic. This study aimed to examine how immunosuppressed patients with inflammatory bowel disease (IBD) responded to the third mRNA vaccination against SARS-CoV-2. The patients were undergoing treatments such as anti-TNF (infliximab, adalimumab), anti-α4ß7 integrin (vedolizumab), anti-IL12/23 (ustekinumab) and azathioprine (purine analog). Their responses were compared to those of healthy individuals.

Methods: In this prospective study, 81 IBD patients and 15 healthy controls were enrolled 2-4 months after receiving the third mRNA vaccination. This study measured IgG antibody levels against the SARS-CoV-2 spike protein's receptor binding domain (RBD) and assessed potential neutralization capacity using a surrogate virus neutralization test (sVNT).

Results: Overall, immunosuppressed IBD patients (without SARS-CoV-2 infection) exhibited significantly lower levels of anti-S-IgG (anti-RBD-IgG) and binding inhibition in the sVNT after the third vaccination compared to healthy controls. Patients under anti-TNF therapy showed notably reduced anti-S-IgG levels after the booster vaccination, in contrast to those receiving ustekinumab and azathioprine (p = 0.030, p = 0.031). IBD patients on anti-TNF therapy demonstrated significantly increased anti-S-IgG levels following prior SARS-CoV-2 infection (p = 0.020).

Conclusion: Even after the third vaccination, immunosuppressed IBD patients exhibited diminished humoral immunity compared to healthy controls, especially those on anti-TNF therapy. Cases of penetrating infections led to considerably higher antibody levels in IBD patients under anti-TNF therapy compared to uninfected patients. Further investigation through prospective studies in immunosuppressed IBD patients is needed to determine whether this effectively safeguards against future infections or severe disease.

Keywords: COVID-19; IBD patients; SARS-CoV-2; humoral immune response; seroconversion; vaccination.

Grants and funding

We acknowledge support from the Open Access Publication Fund of the University of Muenster.