Antibody decay, T cell immunity and breakthrough infections following two SARS-CoV-2 vaccine doses in infliximab- and vedolizumab-treated patients
Lin, S.; Kennedy, N. A.; Saifuddin, A.; Munoz Sandoval, D.; Reynolds, C. J.; Seoane, R. C.; Kottoor, S. H.; Pieper, F. P.; Lin, K.-M.; Butler, D. K.; Chanchlani, N.; Nice, R.; Chee, D.; Bewshea, C.; Janjua, M.; McDonald, T. J.; Sebastian, S.; Alexander, J. L.; Constable, L.; Lee, J. C.; Murray, C. D.; Hart, A. L.; Irving, P. M.; Jones, G.-R.; Kok, K. B.; Lamb, C. A.; Lees, C. W.; Altmann, D. M.; Boyton, R. J.; Goodhand, J. R.; Powell, N.; Ahmad, T.; Contributors to the CLARITY IBD study,
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We report SARS-CoV-2 vaccine-induced immunity and risk of breakthrough infections in patients with inflammatory bowel disease treated with infliximab, a commonly used anti-TNF drug and those treated with vedolizumab, a gut-specific antibody targeting integrin a4b7 that does not impact systemic immunity. In infliximab-treated patients, the magnitude of anti-SARS-CoV2 antibodies was reduced 4-6-fold. One fifth of both infliximab- and vedolizumab-treated patients did not mount a T cell response. Antibody half-life was shorter in infliximab-treated patients. Breakthrough SARS-CoV-2 infections occurred more frequently in infliximab-treated patients and the risk was predicted by the level of antibody response after second vaccine dose. Overall, recipients of two doses of the BNT162b2 vaccine had higher anti-SARS-CoV-2 antibody concentrations, higher seroconversion rates, shorter antibody half-life and less breakthrough infections compared to ChAdOx1 nCoV-19 vaccine recipients. Irrespective of biologic treatment, higher, more sustained antibody levels were observed in patients with a history of SARS-CoV-2 infection prior to vaccination. Patients treated with anti-TNF therapy should be offered third vaccine doses.
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