We thank Garcia Garrido and colleagues for their comments on the British Society of Gastroenterology Inflammatory Bowel Disease (IBD) and IBD Clinical Research Group section position statement1Alexander JL Moran GW Gaya DR et al.SARS-CoV-2 vaccination for patients with inflammatory bowel disease: a British Society of Gastroenterology Inflammatory Bowel Disease section and IBD Clinical Research Group position statement. and the studies cited in their Correspondence, including the valuable meta-analysis of the impact of immunosuppression on pneumococcal vaccination.2van Aalst M Langedijk AC Spijker R de Bree GJ Grobusch MP Goorhuis A The effect of immunosuppressive agents on immunogenicity of pneumococcal vaccination: a systematic review and meta-analysis. However, the results of this meta-analysis should be interpreted with caution in patients with IBD, as most of the studies included (18 of 22) were from patients with other immune-mediated inflammatory diseases (mostly rheumatoid arthritis), in which the only conventional immunomodulator reported was methotrexate. Additionally, in the few IBD studies included, anti-TNF treatment significantly impaired vaccine responses, whereas immunomodulators did not. The 2020 study by van Aalst and colleagues3van Aalst M Garcia Garrido HM van der Leun J et al.Immunogenicity of the currently recommended pneumococcal vaccination schedule in patients with inflammatory bowel disease. also substantiates impaired pneumococcal vaccine (PCV13) responses in patients receiving anti-TNF agents. The key message is that there is clear evidence of impaired pneumococcal vaccine responses in patients with IBD taking anti-TNF therapy, with less clear or conflicting evidence available for conventional immunomodulators.We agree that any impact of immunosuppression is likely to be specific to vaccines. Fortunately, data are now emerging on the effects of immunosuppressive therapies on anti-SARS-CoV-2 vaccine immunogenicity in patients with IBD. Results from 1283 patients with IBD in the CLARITY IBD study have shown that rates of seroconversion are lower after the first dose of both the BNT162b2 (Pfizer/BioNTech) and ChAdOx1 nCoV-19 (Oxford/AstraZeneca) vaccines in patients treated with infliximab than in patients treated with vedolizumab.4Kennedy NA Lin S Goodhand JR et al.Infliximab is associated with attenuated immunogenicity to BNT162b2 and ChAdOx1 nCoV-19 SARS-CoV-2 vaccines in patients with IBD. Anti-TNF monotherapy and immunomodulator monotherapy were not compared; however, the combination of infliximab and immunomodulator therapy was associated with the lowest rates of seroconversion with both vaccines. Whether any particular vaccine should be favoured in patients with IBD is more contentious. No major serological differences were observed in CLARITY IBD between the two vaccines, but there are conceptual reasons to suspect that adenovirus vector vaccines might elicit favourable T-cell responses, which could be important for durable immunity. Data regarding the effects of immunosuppressive therapies on T-cell responses are eagerly anticipated.Important unanswered questions remain. Although early data from small cohorts of patients with IBD treated with anti-TNF agents completing two doses of mRNA vaccination in CLARITY IBD and in the USA5Wong SY Dixon R Pazos VM et al.Serological response to mRNA COVID-19 vaccines in IBD patients receiving biological therapies. report robust vaccination responses, larger studies, including those incorporating data on adenovirus vector vaccines, are urgently needed. Furthermore, the effects on vaccine immunogenicity of other immunosuppressive regimens used in IBD are yet to be systematically investigated.

JLA reports sponsorship from Vifor Pharma for accommodation and travel to British Society of Gastroenterology 2019. NAK reports personal fees from Dr Falk, Janssen, Takeda, and Tillotts; and grants and personal fees from Pharmacosmos. TA reports grants from F Hoffmann-La Roche AG, Janssen, and Galapagos; grants and personal fees from Biogen, Celltrion, and Celgene; non-financial support from AbbVie and Tillotts; personal fees from Arena, Adcock Ingram, Gilead, Pfizer, and Genentech; and grants, personal fees, and non-financial support from Takeda. CWL reports grants and personal fees from Gilead; and personal fees from AbbVie, Takeda, Janssen, Ferring, Trellus Health, Pfizer, Galapagos, and Iterative Scopes. NP reports serving as a speaker for Allergan, Bristol Myers Squibb, Falk, Ferring, Janssen, Pfizer, Tillotts, and Takeda, and as a consultant and/or an advisory board member for AbbVie, Allergan, Celgene, Bristol Myers Squibb, Ferring, and Vifor Pharma.

References1.Alexander JL Moran GW Gaya DR et al.

SARS-CoV-2 vaccination for patients with inflammatory bowel disease: a British Society of Gastroenterology Inflammatory Bowel Disease section and IBD Clinical Research Group position statement.

Lancet Gastroenterol Hepatol. 6: 218-2242.van Aalst M Langedijk AC Spijker R de Bree GJ Grobusch MP Goorhuis A

The effect of immunosuppressive agents on immunogenicity of pneumococcal vaccination: a systematic review and meta-analysis.

Vaccine. 36: 5832-58453.van Aalst M Garcia Garrido HM van der Leun J et al.

Immunogenicity of the currently recommended pneumococcal vaccination schedule in patients with inflammatory bowel disease.

Clin Infect Dis. 70: 595-6044.Kennedy NA Lin S Goodhand JR et al.

Infliximab is associated with attenuated immunogenicity to BNT162b2 and ChAdOx1 nCoV-19 SARS-CoV-2 vaccines in patients with IBD.

Gut. ()5.Wong SY Dixon R Pazos VM et al.

Serological response to mRNA COVID-19 vaccines in IBD patients receiving biological therapies.

Gastroenterology. ()Article InfoPublication HistoryIdentification

DOI: https://doi.org/10.1016/S2468-1253(21)00194-1

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ScienceDirectAccess this article on ScienceDirect Linked ArticlesSARS-CoV-2 vaccination for patients with inflammatory bowel disease

We read with interest the position statement of the British Society of Gastroenterology Inflammatory Bowel Disease (IBD) section and IBD Clinical Research Group.1 Although we largely agree with the key messages that SARS-CoV-2 vaccination should be strongly supported for patients with IBD and that the anticipated risks are low, we wish to raise a few relevant remarks based on previously published studies on vaccination for other pathogens in this patient group. Alexander and colleagues1 rightfully argue that the response to pneumococcal, influenza, and hepatitis A vaccination in patients with IBD receiving immunosuppressive agents is diminished compared with that in control individuals.

Full-Text PDF SARS-CoV-2 vaccination for patients with inflammatory bowel disease: a British Society of Gastroenterology Inflammatory Bowel Disease section and IBD Clinical Research Group position statement

SARS-CoV-2 has caused a global health crisis and mass vaccination programmes provide the best opportunity for controlling transmission and protecting populations. Despite the impressive clinical trial results of the BNT162b2 (Pfizer/BioNTech), ChAdOx1 nCoV-19 (Oxford/AstraZeneca), and mRNA-1273 (Moderna) vaccines, important unanswered questions remain, especially in patients with pre-existing conditions. In this position statement endorsed by the British Society of Gastroenterology Inflammatory Bowel Disease (IBD) section and IBD Clinical Research Group, we consider SARS-CoV-2 vaccination strategy in patients with IBD.

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