Antibody Response to SARS-CoV-2 Vaccination in Patients with Inflammatory Bowel Disease: Results of a Single-Center Cohort Study in a Tertiary Hospital in Germany
Antibody Response to SARS-CoV-2 Vaccination in Patients with Inflammatory Bowel Disease: Results of a Single-Center Cohort Study in a Tertiary Hospital in Germany
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DOI：
10.1159/000521343
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发表时间：
2021-12-10
影响因子：
2.3
通讯作者：
Schnoy, Elisabeth
中科院分区：
文献类型：
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作者：
Classen, Johanna Maria;Muzalyova, Anna;Schnoy, Elisabeth
背景：新冠肺炎是由严重急性呼吸综合征冠状病毒2型(SARS-CoV-2)引起的病毒性疾病，于2019年首次被描述，此后对日常生活产生重大影响。2020年12月，来自BioNTech/辉瑞的第一支新冠肺炎疫苗首次获批。然而，对炎症性肠病(IBD)患者接种疫苗和免疫调节剂或生物制品的免疫反应知之甚少。本研究的目的是调查接受免疫调节剂或生物制剂的IBD患者和健康对照组对接种SARS-CoV-2疫苗的抗体反应。方法：采用回顾性观察设计的单中心研究。研究对象包括72名溃疡性结肠炎或克罗恩病患者。以本院72名健康职工的配对资料为对照组。数据与IBD患者的倾向评分相匹配。两组都采集了血液样本进行抗体反应，两组都接受了随附的问卷调查。结果：IBD组65例(90.3%)患者接受免疫调节治疗。全程免疫后，所有IBD患者的平均抗体水平男性为1,257.1U/mL(标准差)1,109.626，女性为1,500.1U/mL(SD 1142.760)。与健康组相比，IBD组抗体反应降低(IBD组1,383.76U/mLSD 1,125.617；对照组1,885.65U/mLSD 727.572，p<；0.05)。在这组人中，在第一次接种疫苗后平均61.9天采集血样。IBD组接种2次疫苗后未见接种失败。在第一次接种疫苗后，IBD患者报告的副作用，包括肌肉疼痛、注射部位疼痛和疲劳，比对照组更常见(总症状IBD组58.3%，对照组34.5%，p<；0.007)。第二次接种后，对照组副反应较高(总症状率为55.4%，对照组为76%，P=0.077)。老年患者的免疫反应有降低的趋势。病程和伴随的免疫调节治疗(肿瘤坏死因子-α阻滞剂、白介素类、整合素类、甲氨蝶呤或硫唑嘌呤)对免疫反应无影响。然而，对于IBD患者，给予更长时间的药物治疗和疫苗接种时间似乎对抗体水平有积极影响。结论：总体而言，所有IBD患者接种新冠肺炎疫苗2次后均表现出较高的抗体应答。疫苗接种耐受性良好，没有检测到其他不良事件。伴随的免疫调节治疗(肿瘤坏死因子-α阻滞剂、白介素类抑制剂、整合素类抑制剂、甲氨蝶呤或硫唑嘌呤)对血清转换率无影响。随着时间的推移，必须进一步评估抗体效价，以便及早发现这些患者是否需要重新接种疫苗。
Background: COVID-19 is a viral disease caused by severe acute respiratory syndrome corona virus 2 (SARS-CoV-2), first described in 2019, with a significant impact on everyday life since then. In December 2020, the first vaccine against COVID-19 from BioNTech/Pfizer was approved for the first time. However, little is known about the immune response to vaccination in patients with inflammatory bowel disease (IBD) and immunomodulators or biologics. The aim of our study was to investigate antibody response to SARS-CoV-2 vaccination in patients with IBD receiving immunomodulators or biologics compared to healthy controls. Methods: This was a single-center study with a retrospective observational design. Seventy-two patients with ulcerative colitis or Crohn's disease were included. Matching data from 72 healthy employees of our hospital were used as the control group. Data were matched by propensity score to patients with IBD. Blood samples were taken from both groups for antibody response, and both groups received an accompanying questionnaire. Results: Sixty-five (90.3%) patients of the IBD group reported taking immunomodulatory therapy. The mean antibody level for all IBD patients was 1,257.1 U/mL (standard deviation [SD] 1,109.626) in males and 1,500.1 U/mL (SD 1142.760) in female IBD patients after full vaccination. Compared to the healthy group, reduced antibody response could be detected (IBD group 1,383.76 U/mL SD 1,125.617; control group 1,885.65 U/mL SD 727.572, p < 0.05). In this group, blood samples were taken with an average of 61.9 days after the first vaccination. There was no vaccination failure in the IBD group after 2 vaccinations. After the first vaccination, side effects, including muscle pain, pain at the injection site, and fatigue, were reported more often in IBD patients than in the control group (total symptoms IBD group 58.3%, control group 34.5%, p < 0.007). The opposite occurred after the second vaccination when side effects were higher in the control group (total symptoms IBD group 55.4%, control group 76%, p = 0.077). There was a trend to a reduced immune response in elderly patients. Disease duration and concomitant immunomodulatory therapy (TNF-alpha blockers, interleukin inhibitors, integrin inhibitors, methotrexate, or azathioprine) had no impact on the immune response. However, longer time to last medication given and time passed to vaccination in patients with IBD seems to have a positive impact on antibody levels. Conclusion: Overall, we could show a high antibody response to vaccination with COVID-19 in all patients with IBD after 2 vaccinations. Vaccination was well tolerated, and no other adverse events were detected. Concomitant immunomodulatory therapy (TNF-alpha blockers, interleukin inhibitors, integrin inhibitors, methotrexate, or azathioprine) had no impact on seroconversion. Further evaluation of antibody titers over time is mandatory to detect early the need for re-vaccination in these patients.