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Dayam RM, Law JC, Goetgebuer RL, Chao GY, Abe KT, Sutton M, Finkelstein N, Stempak JM, Pereira D, Croitoru D, Acheampong L, Rizwan S, Rymaszewski K, Milgrom R, Ganatra D, Batista NV, Girard M, Lau I, Law R, Cheung MW, Rathod B, Kitaygorodsky J, Samson R, Hu Q, Hardy WR, Haroon N, Inman RD, Piguet V, Chandran V, Silverberg MS, Gingras AC, Watts TH. Accelerated waning of immunity to SARS-CoV-2 mRNA vaccines in patients with immune-mediated inflammatory diseases. JCI Insight 2022; 7:e159721. [PMID: 35471956 PMCID: PMC9220925 DOI: 10.1172/jci.insight.159721] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 04/22/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUNDLimited information is available on the impact of immunosuppressants on COVID-19 vaccination in patients with immune-mediated inflammatory diseases (IMID).METHODSThis observational cohort study examined the immunogenicity of SARS-CoV-2 mRNA vaccines in adult patients with inflammatory bowel disease, rheumatoid arthritis, ankylosing spondylitis, or psoriatic disease, with or without maintenance immunosuppressive therapies. Ab and T cell responses to SARS-CoV-2, including neutralization against SARS-CoV-2 variants, were determined before and after 1 and 2 vaccine doses.RESULTSWe prospectively followed 150 subjects, 26 healthy controls, 9 patients with IMID on no treatment, 44 on anti-TNF, 16 on anti-TNF with methotrexate/azathioprine (MTX/AZA), 10 on anti-IL-23, 28 on anti-IL-12/23, 9 on anti-IL-17, and 8 on MTX/AZA. Ab and T cell responses to SARS-CoV-2 were detected in all participants, increasing from dose 1 to dose 2 and declining 3 months later, with greater attrition in patients with IMID compared with healthy controls. Ab levels and neutralization efficacy against variants of concern were substantially lower in anti-TNF-treated patients than in healthy controls and were undetectable against Omicron by 3 months after dose 2.CONCLUSIONSOur findings support the need for a third dose of the mRNA vaccine and for continued monitoring of immunity in these patient groups.FUNDINGFunded by a donation from Juan and Stefania Speck and by Canadian Institutes of Health (CIHR)/COVID-Immunity Task Force (CITF) grants VR-1 172711 and VS1-175545 (to THW and ACG), CIHR FDN-143250 (to THW), GA2-177716 (to VC, ACG, and THW), and GA1-177703 (to ACG) and the CIHR rapid response network to SARS-CoV-2 variants, CoVaRR-Net (to ACG).
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Affiliation(s)
- Roya M. Dayam
- Lunenfeld-Tanenbaum Research Institute at Mount Sinai Hospital, Sinai Health, Toronto, Ontario, Canada
| | - Jaclyn C. Law
- Department of Immunology, University of Toronto, Toronto, Ontario, Canada
| | - Rogier L. Goetgebuer
- Zane Cohen Centre for Digestive Diseases, Division of Gastroenterology, Mount Sinai Hospital, Sinai Health
| | - Gary Y.C. Chao
- Department of Immunology, University of Toronto, Toronto, Ontario, Canada
| | - Kento T. Abe
- Lunenfeld-Tanenbaum Research Institute at Mount Sinai Hospital, Sinai Health, Toronto, Ontario, Canada
- Department of Molecular Genetics
| | - Mitchell Sutton
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Division of Rheumatology, Department of Medicine, and
| | - Naomi Finkelstein
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Division of Rheumatology, Department of Medicine, and
| | - Joanne M. Stempak
- Zane Cohen Centre for Digestive Diseases, Division of Gastroenterology, Mount Sinai Hospital, Sinai Health
| | - Daniel Pereira
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Division of Rheumatology, Department of Medicine, and
| | - David Croitoru
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Lily Acheampong
- Division of Dermatology, Department of Medicine, Women’s College Hospital, Toronto, Ontario, Canada
| | - Saima Rizwan
- Zane Cohen Centre for Digestive Diseases, Division of Gastroenterology, Mount Sinai Hospital, Sinai Health
| | - Klaudia Rymaszewski
- Zane Cohen Centre for Digestive Diseases, Division of Gastroenterology, Mount Sinai Hospital, Sinai Health
| | - Raquel Milgrom
- Zane Cohen Centre for Digestive Diseases, Division of Gastroenterology, Mount Sinai Hospital, Sinai Health
| | - Darshini Ganatra
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Division of Rheumatology, Department of Medicine, and
| | | | - Melanie Girard
- Department of Immunology, University of Toronto, Toronto, Ontario, Canada
| | - Irene Lau
- Department of Immunology, University of Toronto, Toronto, Ontario, Canada
| | - Ryan Law
- Department of Immunology, University of Toronto, Toronto, Ontario, Canada
| | - Michelle W. Cheung
- Department of Immunology, University of Toronto, Toronto, Ontario, Canada
| | - Bhavisha Rathod
- Lunenfeld-Tanenbaum Research Institute at Mount Sinai Hospital, Sinai Health, Toronto, Ontario, Canada
| | - Julia Kitaygorodsky
- Lunenfeld-Tanenbaum Research Institute at Mount Sinai Hospital, Sinai Health, Toronto, Ontario, Canada
- Department of Molecular Genetics
| | - Reuben Samson
- Lunenfeld-Tanenbaum Research Institute at Mount Sinai Hospital, Sinai Health, Toronto, Ontario, Canada
- Department of Molecular Genetics
| | - Queenie Hu
- Lunenfeld-Tanenbaum Research Institute at Mount Sinai Hospital, Sinai Health, Toronto, Ontario, Canada
| | - W. Rod Hardy
- Lunenfeld-Tanenbaum Research Institute at Mount Sinai Hospital, Sinai Health, Toronto, Ontario, Canada
| | - Nigil Haroon
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Division of Rheumatology, Department of Medicine, and
| | - Robert D. Inman
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Division of Rheumatology, Department of Medicine, and
| | - Vincent Piguet
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Dermatology, Department of Medicine, Women’s College Hospital, Toronto, Ontario, Canada
| | - Vinod Chandran
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Division of Rheumatology, Department of Medicine, and
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Mark S. Silverberg
- Lunenfeld-Tanenbaum Research Institute at Mount Sinai Hospital, Sinai Health, Toronto, Ontario, Canada
- Zane Cohen Centre for Digestive Diseases, Division of Gastroenterology, Mount Sinai Hospital, Sinai Health
| | - Anne-Claude Gingras
- Lunenfeld-Tanenbaum Research Institute at Mount Sinai Hospital, Sinai Health, Toronto, Ontario, Canada
- Department of Molecular Genetics
| | - Tania H. Watts
- Department of Immunology, University of Toronto, Toronto, Ontario, Canada
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52
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Lev-Tzion R, Focht G, Lujan R, Mendelovici A, Friss C, Greenfeld S, Kariv R, Ben-Tov A, Matz E, Nevo D, Barak-Corren Y, Dotan I, Turner D. COVID-19 Vaccine Is Effective in Inflammatory Bowel Disease Patients and Is Not Associated With Disease Exacerbation. Clin Gastroenterol Hepatol 2022; 20:e1263-e1282. [PMID: 34954338 PMCID: PMC8697416 DOI: 10.1016/j.cgh.2021.12.026] [Citation(s) in RCA: 55] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 12/14/2021] [Accepted: 12/16/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Studies have shown decreased response to coronavirus disease 2019 (COVID-19) vaccinations in some populations. In addition, it is possible that vaccine-triggered immune activation could trigger immune dysregulation and thus exacerbate inflammatory bowel diseases (IBD). In this population-based study we used the epi-Israeli IBD Research Nucleus validated cohort to explore the effectiveness of COVID-19 vaccination in IBD and to assess its effect on disease outcomes. METHODS We included all IBD patients insured in 2 of the 4 Israeli health maintenance organizations, covering 35% of the population. Patients receiving 2 Pfizer-BioNTech BNT162b2 vaccine doses between December 2020 and June 2021 were individually matched to non-IBD controls. To assess IBD outcomes, we matched vaccinated to unvaccinated IBD patients, and response was analyzed per medical treatment. RESULTS In total, 12,109 IBD patients received 2 vaccine doses, of whom 4946 were matched to non-IBD controls (mean age, 51 ± 16 years; median follow-up, 22 weeks; interquartile range, 4-24). Fifteen patients in each group (0.3%) developed COVID-19 after vaccination (odds ratio, 1; 95% confidence interval, 0.49-2.05; P = 1.0). Patients on tumor necrosis factor (TNF) inhibitors and/or corticosteroids did not have a higher incidence of infection. To explore IBD outcomes, 707 vaccinated IBD patients were compared with unvaccinated IBD patients by stringent matching (median follow-up, 14 weeks; interquartile range, 2.3-20.4). The risk of exacerbation was 29% in the vaccinated patients compared with 26% in unvaccinated patients (P = .3). CONCLUSIONS COVID-19 vaccine effectiveness in IBD patients is comparable with that in non-IBD controls and is not influenced by treatment with TNF inhibitors or corticosteroids. The IBD exacerbation rate did not differ between vaccinated and unvaccinated patients.
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Affiliation(s)
- Raffi Lev-Tzion
- Juliet Keidan Institute of Pediatric Gastroenterology Hepatology and Nutrition, Shaare Zedek Medical Center, Jerusalem, Israel.
| | - Gili Focht
- Juliet Keidan Institute of Pediatric Gastroenterology Hepatology and Nutrition, Shaare Zedek Medical Center, Jerusalem, Israel,Hebrew University of Jerusalem, Jerusalem, Israel
| | - Rona Lujan
- Juliet Keidan Institute of Pediatric Gastroenterology Hepatology and Nutrition, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Adi Mendelovici
- Juliet Keidan Institute of Pediatric Gastroenterology Hepatology and Nutrition, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Chagit Friss
- Juliet Keidan Institute of Pediatric Gastroenterology Hepatology and Nutrition, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Shira Greenfeld
- Maccabi Health Services and Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Revital Kariv
- Maccabi Health Services and Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Amir Ben-Tov
- Maccabi Health Services and Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel,Dana-Dwek Children’s Hospital, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Eran Matz
- Leumit Health Services, Tel-Aviv, Israel
| | - Daniel Nevo
- Department of Statistics and Operations Research, Tel Aviv University, Tel-Aviv, Israel
| | - Yuval Barak-Corren
- Predictive Medicine Group, Computational Health Informatics Program, Boston Children’s Hospital, Boston, Massachusetts
| | - Iris Dotan
- Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel, and Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Dan Turner
- Juliet Keidan Institute of Pediatric Gastroenterology Hepatology and Nutrition, Shaare Zedek Medical Center, Jerusalem, Israel,Hebrew University of Jerusalem, Jerusalem, Israel
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53
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James D, Jena A, Bharath PN, Choudhury A, Singh AK, Sebastian S, Sharma V. Safety of SARS-CoV-2 vaccination in patients with inflammatory bowel disease: A systematic review and meta-analysis. Dig Liver Dis 2022; 54:713-721. [PMID: 35382972 PMCID: PMC8938236 DOI: 10.1016/j.dld.2022.03.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 03/14/2022] [Accepted: 03/15/2022] [Indexed: 01/25/2023]
Abstract
INTRODUCTION Risk of adverse effects and flare of inflammatory bowel disease (IBD) are frequently cited reasons for COVID-19 vaccine hesitancy. METHODS Electronic databases were searched to identify studies reporting the use of COVID-19 vaccine in IBD. We selected studies reporting the incidence of various adverse effects (local or systemic) and flares of IBD after COVID-19 vaccination. The pooled incidence rates for various adverse effects, stratified for the dose and the type of vaccine (adenoviral or mRNA) were estimated. RESULTS Nine studies (16 vaccination cohorts) were included. The pooled incidence rate of overall adverse events was 0.55 (95%CI, 0.45-0.64, I2= 95%). The pooled incidence rate of local adverse events was 0.64 (0.47-0.78, I2= 100%). The pooled incidence rates of fatigue, headache, myalgia, fever and chills were 0.30 (0.21-0.40, I2= 99%), 0.23 (0.17-0.30, I2= 99%), 0.18 (0.13-0.24, I2= 99%), 0.10 (0.06-0.17, I2= 98%) and 0.15 (0.06-0.3, I2= 86%), respectively. The pooled incidence rates of severe adverse events, adverse events requiring hospitalization and flares of IBD following COVID-19 vaccination were 0.02 (0.00-0.12, I2= 97%), 0.00 (0.00-0.01, I2= 27%) and 0.01 (0.01-0.03, I2= 45%), respectively. CONCLUSION COVID-19 vaccination in patients with IBD appears to be safe with only mild adverse events. Flares of IBD and severe adverse events requiring hospitalization were infrequent.
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Affiliation(s)
- Deepak James
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Anuraag Jena
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Pardhu Neelam Bharath
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Arup Choudhury
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Anupam K. Singh
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Vishal Sharma
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India,Corresponding author
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54
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Cho K, Park S, Kim EY, Koyanagi A, Jacob L, Yon DK, Lee SW, Kim MS, Radua J, Elena D, Il Shin J, Smith L. Immunogenicity of COVID-19 Vaccines in Patients with Diverse Health Conditions: a Comprehensive Systematic Review. J Med Virol 2022; 94:4144-4155. [PMID: 35567325 PMCID: PMC9347877 DOI: 10.1002/jmv.27828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 04/05/2022] [Accepted: 05/03/2022] [Indexed: 11/08/2022]
Abstract
It remains unclear how effective COVID-19 vaccinations will be in patients with weakened immunity due to diseases, transplantation, and dialysis. We conducted a systematic review comparing the efficacy of COVID-19 vaccination in patients with solid tumor, hematologic malignancy, autoimmune disease, inflammatory bowel disease, and patients who received transplantation or dialysis. A literature search was conducted twice using the Medline/PubMed database. As a result, 21 papers were included in the review, and seropositivity rate was summarized by specific type of disease, transplantation, and dialysis. When different papers studied the same type of patient group, a study with a higher number of participants was selected. Most of the solid tumor patients showed a seropositivity rate of more than 80% after the second inoculation, but a low seropositivity was found in certain tumors such as breast cancer. Research in patients with certain types of hematological malignancy and autoimmune diseases has also reported low seropositivity, and this may have been affected by the immunosuppressive treatment these patients receive. Research in patients receiving dialysis or transplantation has reported lower seropositivity rates than the general population, while all patients with inflammatory bowel disease have converted to be seropositive. Meta-analysis validating these results will be needed, and studies will also be needed on methods to protect patients with reduced immunity from COVID-19. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Kyuyeon Cho
- Yonsei University, College of Medicine, Seoul, Republic of Korea
| | - Seoyeon Park
- Yonsei University, College of Medicine, Seoul, Republic of Korea
| | - Eun-Young Kim
- Evidence-Based and Clinical Research Laboratory, Department of Health, Social and Clinical Pharmacy, College of Pharmacy, Chung-Ang University, Seoul, 06974, Korea
| | - Ai Koyanagi
- ICREA, Pg. Lluis Companys 23, 08010, Barcelona, Spain.,Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, 08830, Barcelona, Spain
| | - Louis Jacob
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, 08830, Barcelona, Spain.,Faculty of Medicine, University of Versailles Saint-Quentin-en-Yvelines, 78180, Montigny-le-Bretonneux, France
| | - Dong Keon Yon
- Department of Pediatrics, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Seung Won Lee
- Department of Data Science, Sejong University College of Software Convergence, Seoul, Republic of Korea
| | - Min Seo Kim
- Samsung Advanced Institute for Health Sciences and Technology (SAIHST), Sungkyunkwan University, Samsung Medical Center, Seoul, Republic of Korea
| | - Joaquim Radua
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, SE5 8AB, UK.,Mental Health Networking Biomedical Research Centre (CIBERSAM), 08036, Barcelona, Spain.,Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institute, 11330, Stockholm, Sweden.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036, Barcelona, Spain
| | - Dragioti Elena
- Pain and Rehabilitation Centre, and Department of Health, Medicine and Caring Sciences, Linköping University, SE-581 85 Linköping, Sweden
| | - Jae Il Shin
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Lee Smith
- Centre for Health, Performance and Wellbeing, Anglia Ruskin University, Cambridge, UK
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55
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Wagner A, Garner-Spitzer E, Schötta AM, Orola M, Wessely A, Zwazl I, Ohradanova-Repic A, Weseslindtner L, Tajti G, Gebetsberger L, Kratzer B, Tomosel E, Kutschera M, Tobudic S, Pickl WF, Kundi M, Stockinger H, Novacek G, Reinisch W, Zielinski C, Wiedermann U. SARS-CoV-2-mRNA Booster Vaccination Reverses Non-Responsiveness and Early Antibody Waning in Immunocompromised Patients – A Phase Four Study Comparing Immune Responses in Patients With Solid Cancers, Multiple Myeloma and Inflammatory Bowel Disease. Front Immunol 2022; 13:889138. [PMID: 35634285 PMCID: PMC9133631 DOI: 10.3389/fimmu.2022.889138] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 04/14/2022] [Indexed: 12/16/2022] Open
Abstract
BackgroundIndividuals with secondary immunodeficiencies belong to the most vulnerable groups to succumb to COVID-19 and thus are prioritized for SARS-CoV-2 vaccination. However, knowledge about the persistence and anamnestic responses following SARS-CoV-2-mRNA vaccinations is limited in these patients.MethodsIn a prospective, open-label, phase four trial we analyzed S1-specific IgG, neutralizing antibodies and cytokine responses in previously non-infected patients with cancer or autoimmune disease during primary mRNA vaccination and up to one month after booster.Results263 patients with solid tumors (SOT, n=63), multiple myeloma (MM, n=70), inflammatory bowel diseases (IBD, n=130) and 66 controls were analyzed. One month after the two-dose primary vaccination the highest non-responder rate was associated with lower CD19+ B-cell counts and was found in MM patients (17%). S1-specific IgG levels correlated with IL-2 and IFN-γ responses in controls and IBD patients, but not in cancer patients. Six months after the second dose, 18% of patients with MM, 10% with SOT and 4% with IBD became seronegative; no one from the control group became negative. However, in IBD patients treated with TNF-α inhibitors, antibody levels declined more rapidly than in controls. Overall, vaccination with mRNA-1273 led to higher antibody levels than with BNT162b2. Importantly, booster vaccination increased antibody levels >8-fold in seroresponders and induced anamnestic responses even in those with undetectable pre-booster antibody levels. Nevertheless, in IBD patients with TNF-α inhibitors even after booster vaccination, antibody levels were lower than in untreated IBD patients and controls.ConclusionImmunomonitoring of vaccine-specific antibody and cellular responses seems advisable to identify vaccination failures and consequently establishing personalized vaccination schedules, including shorter booster intervals, and helps to improve vaccine effectiveness in all patients with secondary immunodeficiencies.Trial registrationEudraCT Number: 2021-000291-11
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Affiliation(s)
- Angelika Wagner
- Institute of Specific Prophylaxis and Tropical Medicine, Center for Pathophysiology, Infectiology and Immunology, Medical University Vienna, Vienna, Austria
- *Correspondence: Ursula Wiedermann, ; Angelika Wagner,
| | - Erika Garner-Spitzer
- Institute of Specific Prophylaxis and Tropical Medicine, Center for Pathophysiology, Infectiology and Immunology, Medical University Vienna, Vienna, Austria
| | - Anna-Margarita Schötta
- Institute for Hygiene and Applied Immunology, Center for Pathophysiology, Infectiology and Immunology, Medical University Vienna, Vienna, Austria
| | - Maria Orola
- Institute of Specific Prophylaxis and Tropical Medicine, Center for Pathophysiology, Infectiology and Immunology, Medical University Vienna, Vienna, Austria
| | - Andrea Wessely
- Institute of Specific Prophylaxis and Tropical Medicine, Center for Pathophysiology, Infectiology and Immunology, Medical University Vienna, Vienna, Austria
| | - Ines Zwazl
- Institute of Specific Prophylaxis and Tropical Medicine, Center for Pathophysiology, Infectiology and Immunology, Medical University Vienna, Vienna, Austria
| | - Anna Ohradanova-Repic
- Institute for Hygiene and Applied Immunology, Center for Pathophysiology, Infectiology and Immunology, Medical University Vienna, Vienna, Austria
| | | | - Gabor Tajti
- Institute for Hygiene and Applied Immunology, Center for Pathophysiology, Infectiology and Immunology, Medical University Vienna, Vienna, Austria
| | - Laura Gebetsberger
- Institute for Hygiene and Applied Immunology, Center for Pathophysiology, Infectiology and Immunology, Medical University Vienna, Vienna, Austria
| | - Bernhard Kratzer
- Institute of Immunology, Center for Pathophysiology, Infectiology and Immunology, Medical University Vienna, Vienna, Austria
| | - Elena Tomosel
- Institute of Specific Prophylaxis and Tropical Medicine, Center for Pathophysiology, Infectiology and Immunology, Medical University Vienna, Vienna, Austria
| | - Maximilian Kutschera
- Department of Medicine III, Division of Gastroenterology and Hepatology, Medical University Vienna, Vienna, Austria
| | - Selma Tobudic
- Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna, Austria
| | - Winfried F. Pickl
- Institute of Immunology, Center for Pathophysiology, Infectiology and Immunology, Medical University Vienna, Vienna, Austria
| | - Michael Kundi
- Center for Public Health, Medical University Vienna, Vienna, Austria
| | - Hannes Stockinger
- Institute for Hygiene and Applied Immunology, Center for Pathophysiology, Infectiology and Immunology, Medical University Vienna, Vienna, Austria
| | - Gottfried Novacek
- Department of Medicine III, Division of Gastroenterology and Hepatology, Medical University Vienna, Vienna, Austria
| | - Walter Reinisch
- Department of Medicine III, Division of Gastroenterology and Hepatology, Medical University Vienna, Vienna, Austria
| | - Christoph Zielinski
- Central European Cancer Center, Wiener Privatklinik, Vienna, Austria
- The Central European Cancer Center, Central European Cooperative Oncology Group, Headquater (HQ), Vienna, Austria
| | - Ursula Wiedermann
- Institute of Specific Prophylaxis and Tropical Medicine, Center for Pathophysiology, Infectiology and Immunology, Medical University Vienna, Vienna, Austria
- *Correspondence: Ursula Wiedermann, ; Angelika Wagner,
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Qui M, Le Bert N, Chan WPW, Tan M, Hang SK, Hariharaputran S, Sim JXY, Low JGH, Ng W, Wan WY, Ang TL, Bertoletti A, Salazar E. Favorable vaccine-induced SARS-CoV-2 specific T cell response profile in patients undergoing immune-modifying therapies. J Clin Invest 2022; 132:159500. [PMID: 35536644 PMCID: PMC9197512 DOI: 10.1172/jci159500] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 05/04/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Patients undergoing immune-modifying therapies demonstrate a reduced humoral response after COVID-19 vaccination, but we lack a proper evaluation of the effect of such therapies on vaccine-induced T cell responses. METHODS We longitudinally characterized humoral and spike-specific T cell responses in patients with inflammatory bowel disease (IBD), who were on antimetabolite therapy (azathioprine or methotrexate), TNF inhibitors, and/or other biologic treatment (anti-integrin or anti-p40) for up to 6 months after completing 2-dose COVID-19 mRNA vaccination. RESULTS We demonstrate that a spike-specific T cell response was not only induced in treated patients with IBD at levels similar to those of healthy individuals, but also sustained at higher magnitude for up to 6 months after vaccination, particularly in those treated with TNF inhibitor therapy. Furthermore, the spike-specific T cell response in these patients was mainly preserved against mutations present in SARS-CoV-2 B.1.1.529 (Omicron) and characterized by a Th1/IL-10 cytokine profile. CONCLUSION Despite the humoral response defects, patients under immune-modifying therapies demonstrated a favorable profile of vaccine-induced T cell responses that might still provide a layer of COVID-19 protection. FUNDING This study was funded by the National Centre for Infectious Diseases (NCID) Catalyst Grant (FY2021ES) and the National Research Fund Competitive Research Programme (NRF-CRP25-2020-0003).
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Affiliation(s)
- Martin Qui
- Programme in Emerging Infectious Diseases, Duke-NUS Medical School, Singapore, Singapore
| | - Nina Le Bert
- Programme in Emerging Infectious Diseases, Duke-NUS Medical School, Singapore, Singapore
| | - Webber Pak Wo Chan
- Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore, Singapore
| | - Malcolm Tan
- Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore, Singapore
| | - Shou Kit Hang
- Programme in Emerging Infectious Diseases, Duke-NUS Medical School, Singapore, Singapore
| | - Smrithi Hariharaputran
- Programme in Emerging Infectious Diseases, Duke-NUS Medical School, Singapore, Singapore
| | - Jean Xiang Ying Sim
- Department of Infectious Diseases, Singapore General Hospital, Singapore, Singapore
| | - Jenny Guek Hong Low
- Department of Infectious Diseases, Singapore General Hospital, Singapore, Singapore
| | - Weiling Ng
- Department of Microbiology, Singapore General Hospital, Singapore, Singapore
| | - Wei Yee Wan
- Department of Microbiology, Singapore General Hospital, Singapore, Singapore
| | - Tiing Leong Ang
- Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore, Singapore
| | - Antonio Bertoletti
- Programme in Emerging Infectious Diseases, Duke-NUS Medical School, Singapore, Singapore
| | - Ennaliza Salazar
- Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore, Singapore
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57
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Bhurwal A, Mutneja H, Bansal V, Goel A, Arora S, Attar B, Minacapelli CD, Kochhar G, Chen L, Brant S, Seril D. Effectiveness and safety of SARS-CoV-2 vaccine in Inflammatory Bowel Disease patients: a systematic review, meta-analysis and meta-regression. Aliment Pharmacol Ther 2022; 55:1244-1264. [PMID: 35355306 PMCID: PMC9111455 DOI: 10.1111/apt.16913] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 02/07/2022] [Accepted: 03/18/2022] [Indexed: 12/11/2022]
Abstract
INTRODUCTION There are concerns regarding the effectiveness and safety of SARS-CoV-2 vaccine in inflammatory Bowel Disease (IBD) patients. This systematic review and meta-analysis comprehensively summarises the available literature regarding the safety and effectiveness of SARS-CoV-2 vaccine in IBD. METHODS Three independent reviewers performed a comprehensive review of all original articles describing the response of SARS-CoV-2 vaccines in patients with IBD. Primary outcomes were (1) pooled seroconversion rate SARS-CoV-2 vaccination in IBD patients (2) comparison of breakthrough COVID-19 infection rate SARS-CoV-2 vaccination in IBD patients with control cohort and (3) pooled adverse event rate of SARS-CoV-2 vaccine. All outcomes were evaluated for one and two doses of SARS-CoV-2 vaccine. Meta-regression was performed. Probability of publication bias was assessed using funnel plots and with Egger's test. RESULTS Twenty-one studies yielded a pooled seroconversion rate of 73.7% and 96.8% in IBD patients after one and two doses of SARS-CoV-2 vaccine respectively. Sub-group analysis revealed non-statistically significant differences between different immunosuppressive regimens for seroconversion. Meta-regression revealed that the vaccine type and study location independently influenced seroconversion rates. There was no statistically significant difference in breakthrough infection in IBD patients as compared to control after vaccination. CONCLUSION In summary, the systematic review and meta-analysis suggest that SARS-CoV-2 vaccine is safe and effective in IBD patients.
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Affiliation(s)
- Abhishek Bhurwal
- Division of Gastroenterology and HepatologyRutgers Robert Wood Johnson School of MedicineNew BrunswickNew JerseyUSA
| | - Hemant Mutneja
- Division of Gastroenterology and HepatologyJohn H. Stroger Cook County HospitalChicagoIllinoisUSA
| | - Vikas Bansal
- Division of Pulmonary and Critical CareMayo ClinicRochesterNew YorkUSA
| | - Akshay Goel
- Division of Internal MedicineWestchester Medical CenterValhallaNew YorkUSA
| | - Shilpa Arora
- Division of RheumatologyJohn H. Stroger Cook County HospitalChicagoIllinoisUSA
| | - Bashar Attar
- Division of Gastroenterology and HepatologyJohn H. Stroger Cook County HospitalChicagoIllinoisUSA
| | - Carlos D. Minacapelli
- Division of Gastroenterology and HepatologyRutgers Robert Wood Johnson School of MedicineNew BrunswickNew JerseyUSA
| | - Gursimran Kochhar
- Division of Gastroenterology and HepatologyAllegheny Health NetworkPittsburghPennsylvaniaUSA
| | - Lea Ann Chen
- Division of Gastroenterology and HepatologyRutgers Robert Wood Johnson School of MedicineNew BrunswickNew JerseyUSA
| | - Steve Brant
- Division of Gastroenterology and HepatologyRutgers Robert Wood Johnson School of MedicineNew BrunswickNew JerseyUSA
| | - Darren Seril
- Division of Gastroenterology and HepatologyRutgers Robert Wood Johnson School of MedicineNew BrunswickNew JerseyUSA
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Zacharopoulou E, Orfanoudaki E, Tzouvala M, Tribonias G, Kokkotis G, Kitsou V, Almpani F, Christidou A, Viazis N, Mantzaris GJ, Tsafaridou M, Karmiris K, Theodoropoulou A, Papathanasiou E, Zampeli E, Michopoulos S, Tigkas S, Michalopoulos G, Laoudi E, Karatzas P, Mylonas I, Kyriakos N, Liatsos C, Kafetzi T, Theocharis G, Taka S, Panagiotopoulou K, Koutroubakis IE, Bamias G. Patients With Inflammatory Bowel Diseases Have Impaired Antibody Production After Anti-SARS-CoV-2 Vaccination: Results From a Panhellenic Registry. Inflamm Bowel Dis 2022; 29:228-237. [PMID: 35394529 PMCID: PMC9051580 DOI: 10.1093/ibd/izac068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Four EMA-approved vaccines against SARS-CoV-2 are currently available. Data regarding antibody responses to initial vaccination regimens in patients with inflammatory bowel diseases (IBD) are limited. METHODS We conducted a prospective, controlled, multicenter study in tertiary Greek IBD centers. Participating patients had completed the initial vaccination regimens (1 or 2 doses, depending on the type of COVID-19 vaccine) at least 2 weeks before study enrolment. Anti-S1 IgG antibody levels were measured. Demographic and adverse events data were collected. RESULTS We tested 403 patients (Crohn's disease, 58.9%; male, 53.4%; median age, 45 years) and 124 healthy controls (HCs). Following full vaccination, 98% of patients seroconverted, with mRNA vaccines inducing higher seroconversion rates than viral vector vaccines (P = .021). In total, IBD patients had lower anti-S1 levels than HCs (P < .001). In the multivariate analysis, viral vector vaccines (P < .001), longer time to antibody testing (P < .001), anti-TNFα treatment (P = .013), and age (P = .016) were independently associated with lower anti-S1 titers. Vedolizumab monotherapy was associated with higher antibody levels than anti-TNFα or anti-interleukin-12/IL-23 monotherapy (P = .023 and P = .032). All anti- SARS-CoV-2 vaccines were safe. CONCLUSIONS Patients with IBD have impaired antibody responses to anti-SARS-CoV-2 vaccination, particularly those receiving viral vector vaccines and those on anti-TNFα treatment. Older age also hampers antibody production after vaccination. For those low-response groups, administration of accelerated or prioritized booster vaccination may be considered.
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Affiliation(s)
- Eirini Zacharopoulou
- Department of Gastroenterology, General Hospital of Nikaia Piraeus “Agios Panteleimon,” General Hospital Dytikis Attikis “Agia Varvara,”Athens, Greece
| | - Eleni Orfanoudaki
- Department of Gastroenterology, University Hospital of Heraklion, Medical School, University of Crete, Heraklion Crete, Greece
| | - Maria Tzouvala
- Department of Gastroenterology, General Hospital of Nikaia Piraeus “Agios Panteleimon,” General Hospital Dytikis Attikis “Agia Varvara,”Athens, Greece
| | - George Tribonias
- Department of Gastroenterology, General Hospital of Nikaia Piraeus “Agios Panteleimon,” General Hospital Dytikis Attikis “Agia Varvara,”Athens, Greece
| | - Georgios Kokkotis
- GI Unit, 3rd Academic Department of Internal Medicine, National and Kapodistrian Univeristy of Athens- “Sotiria” General Hospital, Athens, Greece
| | - Vassiliki Kitsou
- GI Unit, 3rd Academic Department of Internal Medicine, National and Kapodistrian Univeristy of Athens- “Sotiria” General Hospital, Athens, Greece
| | - Foteini Almpani
- Department of Gastroenterology, General Hospital of Athens, Evaggelismos, Opthalmiatreion Athinon, Polykliniki, Athens, Greece
| | - Aggeliki Christidou
- Department of Gastroenterology, General Hospital of Athens, Evaggelismos, Opthalmiatreion Athinon, Polykliniki, Athens, Greece
| | - Nikolaos Viazis
- Department of Gastroenterology, General Hospital of Athens, Evaggelismos, Opthalmiatreion Athinon, Polykliniki, Athens, Greece
| | - Gerassimos J Mantzaris
- Department of Gastroenterology, General Hospital of Athens, Evaggelismos, Opthalmiatreion Athinon, Polykliniki, Athens, Greece
| | - Maria Tsafaridou
- Department of Gastroenterology, University Hospital of Heraklion, Medical School, University of Crete, Heraklion Crete, Greece
| | | | | | - Evgenia Papathanasiou
- Department of Gastroenterology, General Hospital of Athens “Alexandra,”Athens, Greece
| | - Evanthia Zampeli
- Department of Gastroenterology, General Hospital of Athens “Alexandra,”Athens, Greece
| | - Spyridon Michopoulos
- Department of Gastroenterology, General Hospital of Athens “Alexandra,”Athens, Greece
| | - Stefanos Tigkas
- **Department of Gastroenterology, General Hospital of Piraeus “Tzaneio,”Piraeus, Greece
| | | | - Efrossini Laoudi
- Department of Gastroenterology, National and Kapodistrian University of Athens, General Hospital of Athens “Laiko,”Athens, Greece
| | - Pantelis Karatzas
- Department of Gastroenterology, National and Kapodistrian University of Athens, General Hospital of Athens “Laiko,”Athens, Greece
| | - Iordanis Mylonas
- Department of Gastroenterology, 401 General Army Hospital of Athens, Athens, Greece
| | - Nikolaos Kyriakos
- Department of Gastroenterology, 401 General Army Hospital of Athens, Athens, Greece
| | - Christos Liatsos
- Department of Gastroenterology, 401 General Army Hospital of Athens, Athens, Greece
| | - Theodora Kafetzi
- Department of Gastroenterology, University Hospital of Patras, Patra, Greece
| | - Georgios Theocharis
- Department of Gastroenterology, University Hospital of Patras, Patra, Greece
| | - Styliani Taka
- StArtBio PC Molecular Diagnostics and Biotechnology Services, Athens, Greece
| | | | - Ioannis E Koutroubakis
- Department of Gastroenterology, University Hospital of Heraklion, Medical School, University of Crete, Heraklion Crete, Greece
| | - Giorgos Bamias
- GI Unit, 3rd Academic Department of Internal Medicine, National and Kapodistrian Univeristy of Athens- “Sotiria” General Hospital, Athens, Greece,Address correspondence to: Giorgos Bamias, MD, PhD, Associate Professor of Gastroenterology, GI Unit, 3rd Academic Dpt. of Internal Medicine, National and Kapodistrian University of Athens, Sotiria Hospital, 152 Mesogeion av. 11527, Tel +30 2107763100, Athens, Greece ()
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59
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Adalimumab/infliximab. REACTIONS WEEKLY 2022. [PMCID: PMC9008658 DOI: 10.1007/s40278-022-13165-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
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60
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Spiera E, Ungaro RC, Kornbluth A. Effectiveness and Safety of COVID-19 Vaccines in Patients With Inflammatory Bowel Disease. Gastroenterol Hepatol (N Y) 2022; 18:145-155. [PMID: 35506005 PMCID: PMC9053483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Vaccines against SARS-CoV-2 are important for protection from COVID-19; however, patients with immune-mediated conditions and patients taking immunosuppressive medications, including patients with inflammatory bowel disease (IBD), were excluded from studies demonstrating the safety and efficacy of these vaccines. This article provides an overview of the research and recommendations currently published on vaccines against COVID-19 in adult populations with IBD, including studies evaluating effects of commonly used medications. COVID-19 vaccines are strongly recommended for patients with IBD. Messenger RNA (mRNA) and adenovirus vector vaccines are safe in patients with IBD, and reports of severe reactions or IBD flares are rare. Studies assessing antibody response, T-cell immunity, and real-world experience demonstrate positive outcomes for mRNA and adenovirus vector vaccines in patients with IBD, although mRNA vaccines may have a slight advantage. Studies assessing inactive COVID-19 vaccines are still needed. Immunosuppressive therapies used in IBD, especially tumor necrosis factor antagonists, combination therapy, and corticosteroids, may reduce antibody responses and durability, but the impact on infection, hospitalizations, and death requires further evaluation. Educating patients with this evidence-based information will likely help to reduce concerns and vaccine hesitancy.
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Affiliation(s)
- Emily Spiera
- The Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ryan C Ungaro
- The Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Asher Kornbluth
- The Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York
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61
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Doherty J, O Morain N, Stack R, Girod P, Tosetto M, Inzitiari R, Sheridan J, Cullen G, Mc Dermott E, Buckley M, Horgan G, Mulcahy H, Ryan EJ, Daghfal D, Doran P, O Morain C, Doherty GA. Reduced Serological Response to COVID-19 Vaccines in Patients with IBD is Further Diminished by TNF Inhibitor Therapy; Early Results of the VARIATION study [VAriability in Response in IBD Against SARS-COV-2 ImmunisatiON]. J Crohns Colitis 2022; 16:1354-1362. [PMID: 35176770 PMCID: PMC8903431 DOI: 10.1093/ecco-jcc/jjac029] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 01/18/2022] [Accepted: 02/15/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIMS Evidence suggests patients with inflammatory bowel disease [IBD] receiving TNF antagonists have attenuated response to vaccination against COVID-19. We sought to determine the impact of IBD and of various medications for treatment of IBD on antibody responses to vaccination against COVID-19. METHODS Patients with IBD [n = 270] and healthy controls [HC, n = 116] were recruited prospectively, and quantitative antibody responses were assessed following COVID-19 vaccination. The impact of IBD and of medications for treatment of IBD on vaccine response rates was investigated. RESULTS Of HC, 100% seroconverted following complete vaccination with two vaccine doses; 2% of patients with IBD failed to seroconvert. Median anti-spike protein [SP] immunoglobulin [Ig]G levels following complete vaccination in our IBD cohort was significantly lower than among HC [2613 AU/mL versus 6871 AU/mL, p ≤0.001]. A diagnosis of IBD was independently associated with lower anti-SP IgG levels [β coefficient -0.2, p = 0.001]. Use of mRNA vaccines was independently associated with higher anti-SP IgG levels [β coefficient 0.25, p ≤0.001]. Patients with IBD receiving TNF inhibitors had significantly lower anti-SP IgG levels [2445 AU/mL] than IBD patients not receiving TNF inhibitors [3868 AU/mL, p ≤0.001]. Patients with IBD not receiving TNF inhibitors still showed attenuated responses compared with HC [3868 AU/mL versus 8747 AU/mL, p = 0.001]. CONCLUSIONS Patients with IBD have attenuated serological responses to SARS-CoV-2 vaccination. Use of anti-TNF therapy negatively affects anti-SP IgG levels further. Patients who do not seroconvert following vaccination are a particularly vulnerable cohort. Impaired responses to vaccination in our study highlight the importance of booster vaccination programmes for patients with IBD.
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Affiliation(s)
- Jayne Doherty
- Centre for Colorectal Disease, St Vincent’s University Hospital, Dublin,School of Medicine, University College Dublin, Dublin,INITIative IBD research network,Corresponding author: Dr Jayne Doherty Centre for Colorectal Disease St Vincent’s University Hospital Elm Park Dublin 4 00353876419786
| | - Neil O Morain
- Centre for Colorectal Disease, St Vincent’s University Hospital, Dublin,School of Medicine, University College Dublin, Dublin
| | - Roisin Stack
- Centre for Colorectal Disease, St Vincent’s University Hospital, Dublin,School of Medicine, University College Dublin, Dublin
| | - Parker Girod
- Centre for Colorectal Disease, St Vincent’s University Hospital, Dublin
| | | | | | - Juliette Sheridan
- Centre for Colorectal Disease, St Vincent’s University Hospital, Dublin,School of Medicine, University College Dublin, Dublin,St Vincent’s Private Hospital, Dublin
| | - Garret Cullen
- Centre for Colorectal Disease, St Vincent’s University Hospital, Dublin,School of Medicine, University College Dublin, Dublin,St Vincent’s Private Hospital, Dublin,INITIative IBD research network
| | - Edel Mc Dermott
- Centre for Colorectal Disease, St Vincent’s University Hospital, Dublin,St Vincent’s Private Hospital, Dublin
| | - Maire Buckley
- Centre for Colorectal Disease, St Vincent’s University Hospital, Dublin,St Vincent’s Private Hospital, Dublin,St Michaels Hospital, Dun Laoghaire, Co Dublin
| | - Gareth Horgan
- Centre for Colorectal Disease, St Vincent’s University Hospital, Dublin,St Vincent’s Private Hospital, Dublin,St Columcille’s Hospital, Loughlinstown, Co Dublin
| | - Hugh Mulcahy
- Centre for Colorectal Disease, St Vincent’s University Hospital, Dublin,School of Medicine, University College Dublin, Dublin,St Vincent’s Private Hospital, Dublin
| | - Elizabeth J Ryan
- Department of Biological Sciences, Health Research Institute, University of Limerick, Limerick, Ireland
| | - David Daghfal
- Abbott Laboratories, Abbott Diagnostics, Lake Forest, IL
| | - Peter Doran
- School of Medicine, University College Dublin, Dublin
| | - Colm O Morain
- Beacon Hospital, Sandyford, Co. Dublin and Trinity College Dublin,INITIative IBD research network
| | - Glen A Doherty
- Centre for Colorectal Disease, St Vincent’s University Hospital, Dublin,School of Medicine, University College Dublin, Dublin,St Vincent’s Private Hospital, Dublin,INITIative IBD research network
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62
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Orfanoudaki E, Zacharopoulou E, Kitsou V, Karmiris K, Theodoropoulou A, Mantzaris GJ, Tzouvala M, Michopoulos S, Zampeli E, Michalopoulos G, Karatzas P, Viazis N, Liatsos C, Bamias G, Koutroubakis IE. Real-World Use and Adverse Events of SARS-CoV-2 Vaccination in Greek Patients with Inflammatory Bowel Disease. J Clin Med 2022; 11:jcm11030641. [PMID: 35160092 PMCID: PMC8836981 DOI: 10.3390/jcm11030641] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 01/12/2022] [Accepted: 01/19/2022] [Indexed: 02/06/2023] Open
Abstract
Since inflammatory bowel disease (IBD) patients were excluded from vaccine authorization studies, limited knowledge exists regarding perceptions and unfavorable effects of COVID-19 vaccination in this group. We aimed to investigate the real-world use and adverse events (AEs) of COVID-19 vaccines in Greek IBD patients. Fully vaccinated IBD patients followed in Greek centers were invited to participate. All patients filled out an anonymous online survey concerning the vaccination program, which included information regarding demographics, clinical characteristics, treatment, vaccination perceptions and potential AEs. Overall, 1007 IBD patients were included. Vaccine hesitancy was reported by 49%. Total AEs to vaccination were reported by 81% after dose 1 (D1) and 76% after dose 2 (D2), including isolated injection site reactions (36% and 24% respectively). Systemic AEs were more common after D2 (51%, D2 vs. 44%, D1, p < 0.0001). Very few patients reported new onset abdominal symptoms (abdominal pain 4% (D1), 6% (D2) and diarrhea 5% (D1), 7% (D2)). There were no serious AEs leading to emergency room visit or hospitalization. In multivariate analysis, AEs occurrence was positively associated with young age and female gender (p < 0.0005 for both doses), whereas inactive disease was negatively associated with AE in D1 (p = 0.044). SARS-CoV-2 vaccination in Greek IBD patients demonstrated a favorable and reassuring safety profile.
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Affiliation(s)
- Eleni Orfanoudaki
- Department of Gastroenterology, University Hospital of Heraklion, Medical School, University of Crete, 71110 Heraklion, Greece;
- Correspondence: ; Tel.: +30-2810392745; Fax: +30-2810542085
| | - Eirini Zacharopoulou
- Department of Gastroenterology, General Hospital of Nikaia Piraeus “Ag. Panteleimon”-General Hospital Dytikis Attikis “Agia Varvara”, 12351 Athens, Greece; (E.Z.); (M.T.)
| | - Vassiliki Kitsou
- Gastroenterology Unit, 3rd Academic Department of Internal Medicine, National and Kapodistrian Univeristy of Athens, “Sotiria” General Hospital, 11527 Athens, Greece; (V.K.); (G.B.)
| | - Konstantinos Karmiris
- Department of Gastroenterology, Venizelio General Hospital, 71409 Heraklion, Greece; (K.K.); (A.T.)
| | - Angeliki Theodoropoulou
- Department of Gastroenterology, Venizelio General Hospital, 71409 Heraklion, Greece; (K.K.); (A.T.)
| | - Gerassimos J. Mantzaris
- Department of Gastroenterology, General Hospital of Athens, Evaggelismos-Polykliniki, 10676 Athens, Greece; (G.J.M.); (N.V.)
| | - Maria Tzouvala
- Department of Gastroenterology, General Hospital of Nikaia Piraeus “Ag. Panteleimon”-General Hospital Dytikis Attikis “Agia Varvara”, 12351 Athens, Greece; (E.Z.); (M.T.)
| | - Spyridon Michopoulos
- Department of Gastroenterology, General Hospital of Athens “Alexandra”, 11528 Athens, Greece; (S.M.); (E.Z.)
| | - Evanthia Zampeli
- Department of Gastroenterology, General Hospital of Athens “Alexandra”, 11528 Athens, Greece; (S.M.); (E.Z.)
| | - Georgios Michalopoulos
- Department of Gastroenterology, General Hospital of Piraeus “Tzaneio”, Piraeus, 18536 Athens, Greece;
| | - Pantelis Karatzas
- Department of Gastroenterology, National and Kapodistrian University of Athens, General Hospital of Athens “Laiko”, 11527 Athens, Greece;
| | - Nikos Viazis
- Department of Gastroenterology, General Hospital of Athens, Evaggelismos-Polykliniki, 10676 Athens, Greece; (G.J.M.); (N.V.)
| | - Christos Liatsos
- Gastroenterology Department, 401 General Army Hospital of Athens, 11525 Athens, Greece;
| | - Giorgos Bamias
- Gastroenterology Unit, 3rd Academic Department of Internal Medicine, National and Kapodistrian Univeristy of Athens, “Sotiria” General Hospital, 11527 Athens, Greece; (V.K.); (G.B.)
| | - Ioannis E. Koutroubakis
- Department of Gastroenterology, University Hospital of Heraklion, Medical School, University of Crete, 71110 Heraklion, Greece;
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Dai C, Dong ZY, Wang YN, Huang YH, Jiang M. Impact of SARS-CoV-2 vaccination in inflammatory bowel disease patients with different biological agents: a systematic review and meta-analysis. REVISTA ESPAÑOLA DE ENFERMEDADES DIGESTIVAS 2022; 114. [DOI: 10.17235/reed.2022.9264/2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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