Could IBD Medication Reduce Your COVID Vaccine Response?
We asked a leading gastroenterologist to put the emerging research into context.
The chronic community is accustomed to dealing with unique and frustrating challenges. This has been especially true during the COVID-19 pandemic, when the entire world is rife with uncertainty surrounding public health and safety. People with autoimmune diseases are considered a high-risk group for serious outcomes from a COVID infection, yet they were not a population included in the initial rounds of vaccine clinical trials.
This has left chronic folks in a tough spot: having to be extremely vigilant about COVID precautions while knowing relatively little about how these new vaccines will work for them. To top it off, new research in the journal Gut created a stir this week when researchers reported uncertainty around how effective the vaccines might be for this group. In the study, scientists measured the antibody counts of IBD patients after their first dose of the Pfizer or AstraZeneca COVID vaccine. They found that people on Remicade (infliximab) had a lowered immune response to their first vaccine dose compared to patients on Entivyio (vedolizumab).
Does this mean that certain immunosuppressant medications could make the COVID vaccine less effective? We wanted to hear straight from an expert, so we called up Alexander Levy, M.D., gastroenterologist at Tufts Medical Center in Boston. He helped put this study into context and allayed some concerns along the way.
HealthCentral: What do we know about the safety and effectiveness of COVID vaccines for people with IBD?
Alexander Levy, M.D.: The three primary vaccines that have come out [in the U.S.—Pfizer, Moderna, and Johnson & Johnson] are not tailored to IBD patients. They included folks who have immune-related diseases in clinical trials but excluded those who were immunosuppressed. But it’s important to understand that all three of these vaccines went through extensive evaluation with three phases of clinical trials and tens of thousands of individuals. So, while we don’t have direct evidence [involving IBD patients], there is a large body of evidence for the general population that the COVID vaccines have been demonstrated to be effective and safe.
HC: A new study in the journal Gut indicates that the biologic drug infliximab is associated with a dampened immune response to the first dose of the COVID vaccine. What does this mean?
Dr. Levy: This was a UK-based study that looked at immune response, meaning antibody development, after the first vaccine dose for patients on two separate drugs: infliximab and vedolizumab. What they found was that patients who were on infliximab had a decreased immune response to the initial dose of the vaccine.
Now, this is very important: The two vaccines they studied [Pfizer and AstraZeneca] are intended to have two doses, and this study only looked at people’s immune response after the first dose. This study is more important in the UK because they have a different public health strategy. In an effort to get more people vaccinated, they were trying to see if a single dose might be effective enough, but these vaccines were intended to be given in two doses. In the United States, we don’t have that issue; we are not giving people only one shot when they are intended to have two.
So when we look at this study, we shouldn’t assume that people on infliximab won’t be able to mount an appropriate response to the second dose, which is when the more robust immune response usually happens.
HC: The Johnson & Johnson vaccine is given as a single dose, and it already has a lower efficacy rate than the two mRNA vaccines. Since this study was looking at single doses, do IBD patients who got the J&J vaccine need to be worried about their immune response?
Dr. Levy: Unfortunately, without head-to-head studies, it is difficult to comment of the effectiveness of the J&J vaccine in IBD. I can only say that in the general population, the J&J vaccine saw higher immune response with the first vaccine, which is why it was ultimately approved as a single dose.
HC: Is there other research being done about COVID vaccines for people with IBD?
Dr. Levy: There is more early data starting to come out: In the New York ICARUS study [currently in pre-print], researchers looked at 48 IBD patients and compared them to healthy controls. They found that IBD patients who received both doses of the COVID vaccine mounted a normal or similar vaccine response [to the healthy controls], regardless of the medications they were on. It’s a small study, but it’s encouraging that our IBD patients who are receiving all intended doses of the vaccine seem to mount an appropriate response.
Two larger studies will be looking at this in greater detail—one is based out of Cedars-Sinai and one is based out of the University of North Carolina. They are looking at antibody responses with the full vaccine doses, and we’ll have to wait and see when those results come out. But again, I would say that it’s important to make sure that in vaccines that are intended to have two doses, our IBD patients are getting that second dose.
HC: Is there any evidence that one COVID vaccine—Pfizer, Moderna, or Johnson & Johnson—is better than the others for people with IBD?
Dr. Levy: The short version is that we don’t know. We would essentially have to be able to study the vaccines head-to-head. Those two forthcoming studies that I mentioned will be looking at this retrospectively, and we’ll have to see if there is any difference, not only across the board with our IBD patients, but also specific immune responses based upon patients’ medication.
HC: What would you say to people with IBD who might be concerned?
Dr. Levy: This new study brings up important points, but I think it’s important to keep things in context. From a safety perspective with preliminary data, we’re not seeing any [concerns] related to IBD patients, regardless of medication use. Early data does not suggest decreased efficacy if you’re taking both doses.
That being said, I do understand there will be patients who remain hesitant, and it’s important for anyone who has questions to speak to their healthcare provider. The Crohn’s & Colitis Foundation offers resources on a variety of topics for IBD patients, including topics related to COVID. They work hand-in-hand with researchers, and a lot of incoming data is posted on their website.
I think it’s also important to keep in context that with every medication, there comes potential side effects. One has to weigh the risk versus the benefit. Even if there is some risk [of lowered immune response] with these vaccines, there’s also the risk of not getting the vaccine and having increased exposure or a bad COVID outcome. That probably outweighs the potential risks we currently see with the vaccine.
Myself, other IBD specialists, and various governing bodies, including the Crohn’s & Colitis Foundation, are all in favor of getting the COVID vaccine to give at least some protection to our patients. I want to encourage that people reach out to their doctors with any concerns.
- UK Infliximab Study: Gut. (2021.) “Anti-SARS-CoV-2 antibody responses are attenuated in patients with IBD treated with infliximab.” gut.bmj.com/content/70/5/865
- ICARUS Study: medRxiv. (2021.) “Serological response to COVID-19 vaccination in IBD patients receiving biologics.” medrxiv.org/content/10.1101/2021.03.17.21253848v1
- Forthcoming IBD Studies: Crohn’s & Colitis Foundation. (2021.) “COVID-19 Vaccine Monitoring.” crohnscolitisfoundation.org/coronavirus/vaccine-monitoring