Should You Get the COVID Vaccine If You Have IBD?
We took your pressing questions to a top gastroenterologist for the bottom line on vaccine safety and efficacy when you’re living with IBD.
The COVID-19 vaccines are here, and they’re being distributed by the millions. Chances are, you know at least one person who has received one. But as welcome as these long-awaited shots are, they’re also stirring up some controversy—especially among those in the chronic community, who (understandably) have some questions. Like are these vaccines safe for everyone? And will they interact with my medications? Also, what are the side-effect risks?
For more info on IBD and the COVID Vaccine, check out our Facebook Live event, here!
We hear you. And we’re taking your questions straight from our Facebook pages to the desks of top chronic disease experts as part of our original series #ChronicVaxFacts. Today, we’re speaking to Gil Melmed, M.D., a gastroenterologist and director of inflammatory bowel disease research at Cedars-Sinai hospital in Los Angeles. Dr. Melmed is co-author of a new set of recommendations by the International Organization for the Study of Inflammatory Bowel Disease (IOIBD) advising IBD patients and their doctors about the COVID-19 vaccines. Here’s what he told us.
HealthCentral: Could the COVID vaccine cause an IBD flare?
Gil Melmed, M.D.: There is no reason to think that it would. I base that on what we know from other vaccines—we have a number of studies with influenza vaccines, pneumococcal vaccines, shingles vaccines, and others that have been done in IBD populations and other chronic immune-mediated conditions. Those studies suggest no increased risk of a flare-up of underlying immune-mediated conditions, and specifically, none of the IBD studies have shown a risk of IBD flare. That being said, these vaccines are new and different, so we’re learning as much as we can, as quickly as we can, from real-world experience.
HC: Is it safe to take the vaccine while on immunomodulators or biologics?
Dr. Melmed: There’s no reason to think that it’s not safe. Again, that’s based on a tremendous amount of evidence from other vaccines, and also based on what we understand about the new mRNA and viral vector vaccines.
HC: Should I stop taking my IBD medication before getting the COVID vaccine?
Dr. Melmed: No. We don’t recommend that people stop taking medications, and we don’t recommend that people time their vaccine around their medications in any specific way.
This is also based on what we know from experience with other vaccines. There have been clinical trials where patients have been randomized to receive a flu vaccine at the time of a biologic infusion or halfway through their biologic infusion cycle, and that showed there was no difference in safety or effectiveness of the vaccine depending on the time it was given.
Based on that aggregate evidence, it’s fine to get the vaccine while on your medication. One should not stop their medication in order to get the COVID-19 vaccine, and one really should get the vaccine at the earliest opportunity to do so.
HC: Is one vaccine better than another if I take IBD medications?
Dr. Melmed: It’s hard to specifically answer this question because people with IBD on immunosuppressant medications were not included in the trials. But based on the totality of the evidence, the two mRNA vaccines are exceedingly safe and extremely effective, and there is really no reason to think there are meaningful differences between them.
The Johnson & Johnson vaccine is a non-replicating viral vector vaccine, and is therefore safe in people with IBD even on immunosuppressive therapies. There is no reason to favor one vaccine brand over another—the most effective vaccine is going to be the one you can get at the earliest opportunity to do so.
HC: Will the vaccine side effects be more severe for people with IBD?
Dr. Melmed: We don’t know the answer to that, but our current research will hopefully give us an indication. The rate of side effects in the populations that were studied—which did include people with various compromising health conditions—suggests that the side effects are usually mild and self-limited. One of these side effects does fall in the GI category: nausea, vomiting, or diarrhea. So, the question might be, are patients who experience those symptoms experiencing side effects of the vaccine, or are they experiencing a flare in their IBD? Thus far, there have been no published reports of a true flare of IBD related to COVID vaccination.
HC: People with autoimmune diseases were not included in the clinical trials. So are we guinea pigs now?
Dr. Melmed: There are going to be unknowns for anything new that comes out. We don’t even know how long the COVID-19 vaccine will protect healthy people against infection. But the totality of evidence we have, based on robust literature and experience with other vaccines, does not suggest any risk from a safety standpoint and does not suggest a concern that the vaccines won’t be as effective with IBD. There is a theoretical risk that for some people on certain medications—for example, steroids—the duration of vaccine protection may be diminished because these medications may lead to a less robust immune response. So we may have to develop booster shots or other forms of maintaining protection over time.
HC: What are scientists doing to get data on vaccine safety for people with IBD, and when will we have access to that information?
Dr. Melmed: We at Cedars-Sinai have launched a registry for our patients and patients around the country who are interested in participating, and we are asking these exact questions. Using various scientific ways of looking at immunity, we’re trying to understand what happens after somebody gets a vaccine. What kind of side effects do our patients experience? How long does that immunity last, and what is the quality of immunity over time? We’re studying patients every couple of months for a year, and it may turn out that we need to study them longer than that. There are other registries going on around the country and around the world to address these same questions.
HC: As someone with IBD, is there anything else I should know about the COVID vaccine?
Dr. Melmed: While we don’t know all the answers about the safety and effectiveness of vaccines in the IBD population, we do know the risks of COVID-19. I think it’s very important in any discussion of risks and benefits that we not just focus on the risks of a vaccine. The risk of getting COVID-19 is very real and well-established. It really behooves anybody who is concerned to not just consider the risks of getting a vaccine, but also to consider the risks of getting COVID-19. Given how effective these vaccines are against preventing severe COVID-19, you need to take that into consideration.
IOIBD Consensus Recommendations: BMJ. (2021.) “SARS-CoV-2 vaccination for patients with inflammatory bowel diseases: recommendations from an international consensus meeting.” gut.bmj.com/content/gutjnl/early/2021/01/20/gutjnl-2020-324000.full.pdf