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COVID-19 Vaccination in Adults with Inflammatory Bowel Disease

July 10, 2023

A recent review article covers current knowledge about COVID-19 vaccination in those with inflammatory bowel disease (IBD), which includes Crohn’s disease and ulcerative colitis. The authors concluded that IBD patients are not at increased risk of infection or serious illness from Covid-19. With the exception of patients taking corticosteroids, most IBD therapies have been shown not to increase the risk of covid-19. There is even evidence that biologics, including anti-TNF, anti-integrins, and anti-interleukin (IL) 12/23 therapies, can decrease the likelihood of hospitalization and/or death due to COVID-19 infection. 

Current research suggests that patients with IBD have a normal ability to generate humoral immunity from vaccination. Several studies have shown that those with IBD, generate antibodies after vaccination at similar rates to healthy controls (1) (2) (3) (4). However, the seroconversion (ability to generate antibodies following vaccination) rates for those on anti-TNF therapy, tofacitinib, and systemic corticosteroids are slightly lower. Cell-mediated immunity, even for patients on immunosuppressant medications, was similar to that of healthy controls (except for patients on tofacitinib, who had a slightly lower response). So far, no relationship has been found between biologic drug levels at the time of vaccination and vaccine response.

IBD has not been associated with increased rates of adverse effects from vaccines. Several studies have reported similar rates of adverse effects in IBD patients as in the general population. While previous studies expressed a concern that the drug mesalamine was associated with an increased risk of severe effects, current findings suggest this was a side effect of biased reporting, and found no increased risk associated with the medication. There is also evidence that vaccination does not increase the risk of IBD flares.

Current research supports Covid-19 vaccination for all IBD patients following CDC recommendations. An additional booster is recommended for patients who are moderately to severely immunosuppressed (those on high doses of prednisone, taking anti-TNF agents, or immunomodulators including thiopurines and methotrexate). While having IBD does not increase the risk of contracting covid or developing severe disease, being unvaccinated is a known risk factor; evidence supports vaccination for all IBD patients.

Citations for report:

Alexander, J. L., Liu, Z., Muñoz Sandoval, D., Reynolds, C., Ibraheim, H., Anandabaskaran, S., Saifuddin, A., Castro Seoane, R., Anand, N., Nice, R., Bewshea, C., D’Mello, A., Constable, L., Jones, G. R., Balarajah, S., Fiorentino, F., Sebastian, S., Irving, P. M., Hicks, L. C., Williams, H. R. T., … VIP study investigators (2022). COVID-19 vaccine-induced antibody and T-cell responses in immunosuppressed patients with inflammatory bowel disease after the third vaccine dose (VIP): a multicentre, prospective, case-control study. The lancet. Gastroenterology & hepatology, 7(11), 1005–1015. https://doi.org/10.1016/S2468-1253(22)00274-6

Brenner, E. J., Ungaro, R. C., Gearry, R. B., Kaplan, G. G., Kissous-Hunt, M., Lewis, J. D., Ng, S. C., Rahier, J. F., Reinisch, W., Ruemmele, F. M., Steinwurz, F., Underwood, F. E., Zhang, X., Colombel, J. F., & Kappelman, M. D. (2020). Corticosteroids, But Not TNF Antagonists, Are Associated With Adverse COVID-19 Outcomes in Patients With Inflammatory Bowel Diseases: Results From an International Registry. Gastroenterology, 159(2), 481–491.e3. https://doi.org/10.1053/j.gastro.2020.05.032

Lev-Tzion, R., Focht, G., Lujan, R., Mendelovici, A., Friss, C., Greenfeld, S., Kariv, R., Ben-Tov, A., Matz, E., Nevo, D., Barak-Corren, Y., Dotan, I., & Turner, D. (2022). COVID-19 Vaccine Is Effective in Inflammatory Bowel Disease Patients and Is Not Associated With Disease Exacerbation. Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association, 20(6), e1263–e1282. https://doi.org/10.1016/j.cgh.2021.12.026

Long, M. D., Weaver, K. N., Zhang, X., Chun, K., Kappelman, M. D., & PREVENT-COVID Study Group (2022). Strong Response to SARS-CoV-2 Vaccine Additional Doses Among Patients With Inflammatory Bowel Diseases. Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association, 20(8), 1881–1883.e1. https://doi.org/10.1016/j.cgh.2022.01.056

Lutz, M., Lazarus, S., & Caldera, F. (2023). COVID-19 vaccination in adults with inflammatory bowel disease. Therapeutic advances in gastroenterology, 16, 17562848231173130. https://doi.org/10.1177/17562848231173130

Quan, J., Ma, C., Panaccione, R., Hracs, L., Sharifi, N., Herauf, M., Makovinović, A., Coward, S., Windsor, J. W., Caplan, L., Ingram, R. J. M., Kanji, J. N., Tipples, G., Holodinsky, J. K., Bernstein, C. N., Mahoney, D. J., Bernatsky, S., Benchimol, E. I., Kaplan, G. G., & STOP COVID-19 in IBD Research Group (2023). Serological responses to three doses of SARS-CoV-2 vaccination in inflammatory bowel disease. Gut, 72(4), 802–804. https://doi.org/10.1136/gutjnl-2022-327440

Schell, T. L., Knutson, K. L., Saha, S., Wald, A., Phan, H. S., Almasry, M., Chun, K., Grimes, I., Lutz, M., Hayney, M. S., Farraye, F. A., & Caldera, F. (2022). Humoral Immunogenicity of 3 COVID-19 Messenger RNA Vaccine Doses in Patients With Inflammatory Bowel Disease. Inflammatory bowel diseases, 28(11), 1781–1786. https://doi.org/10.1093/ibd/izac082

Ungaro, R. C., Brenner, E. J., Agrawal, M., Zhang, X., Kappelman, M. D., Colombel, J. F., & Surveillance Epidemiology of Coronavirus Under Research Exclusion for Inflammatory Bowel Disease (SECURE-IBD) Research Group (2022). Impact of Medications on COVID-19 Outcomes in Inflammatory Bowel Disease: Analysis of More Than 6000 Patients From an International Registry. Gastroenterology, 162(1), 316–319.e5. https://doi.org/10.1053/j.gastro.2021.09.011





Sources

  1. Article Sources and Footnotes

    1. Alexander, J. L., Liu, Z., Muñoz Sandoval, D., Reynolds, C., Ibraheim, H., Anandabaskaran, S., Saifuddin, A., Castro Seoane, R., Anand, N., Nice, R., Bewshea, C., D’Mello, A., Constable, L., Jones, G. R., Balarajah, S., Fiorentino, F., Sebastian, S., Irving, P. M., Hicks, L. C., Williams, H. R. T., … VIP study investigators (2022). COVID-19 vaccine-induced antibody and T-cell responses in immunosuppressed patients with inflammatory bowel disease after the third vaccine dose (VIP): a multicentre, prospective, case-control study. The lancet. Gastroenterology & hepatology, 7(11), 1005–1015. https://doi.org/10.1016/S2468-1253(22)00274-6

    2. Brenner, E. J., Ungaro, R. C., Gearry, R. B., Kaplan, G. G., Kissous-Hunt, M., Lewis, J. D., Ng, S. C., Rahier, J. F., Reinisch, W., Ruemmele, F. M., Steinwurz, F., Underwood, F. E., Zhang, X., Colombel, J. F., & Kappelman, M. D. (2020). Corticosteroids, But Not TNF Antagonists, Are Associated With Adverse COVID-19 Outcomes in Patients With Inflammatory Bowel Diseases: Results From an International Registry. Gastroenterology, 159(2), 481–491.e3. https://doi.org/10.1053/j.gastro.2020.05.032

    3. Lev-Tzion, R., Focht, G., Lujan, R., Mendelovici, A., Friss, C., Greenfeld, S., Kariv, R., Ben-Tov, A., Matz, E., Nevo, D., Barak-Corren, Y., Dotan, I., & Turner, D. (2022). COVID-19 Vaccine Is Effective in Inflammatory Bowel Disease Patients and Is Not Associated With Disease Exacerbation. Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association, 20(6), e1263–e1282. https://doi.org/10.1016/j.cgh.2021.12.026

    4. Long, M. D., Weaver, K. N., Zhang, X., Chun, K., Kappelman, M. D., & PREVENT-COVID Study Group (2022). Strong Response to SARS-CoV-2 Vaccine Additional Doses Among Patients With Inflammatory Bowel Diseases. Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association, 20(8), 1881–1883.e1. https://doi.org/10.1016/j.cgh.2022.01.056

    5. Lutz, M., Lazarus, S., & Caldera, F. (2023). COVID-19 vaccination in adults with inflammatory bowel disease. Therapeutic advances in gastroenterology, 16, 17562848231173130. https://doi.org/10.1177/17562848231173130

    6. Quan, J., Ma, C., Panaccione, R., Hracs, L., Sharifi, N., Herauf, M., Makovinović, A., Coward, S., Windsor, J. W., Caplan, L., Ingram, R. J. M., Kanji, J. N., Tipples, G., Holodinsky, J. K., Bernstein, C. N., Mahoney, D. J., Bernatsky, S., Benchimol, E. I., Kaplan, G. G., & STOP COVID-19 in IBD Research Group (2023). Serological responses to three doses of SARS-CoV-2 vaccination in inflammatory bowel disease. Gut, 72(4), 802–804. https://doi.org/10.1136/gutjnl-2022-327440

    7. Schell, T. L., Knutson, K. L., Saha, S., Wald, A., Phan, H. S., Almasry, M., Chun, K., Grimes, I., Lutz, M., Hayney, M. S., Farraye, F. A., & Caldera, F. (2022). Humoral Immunogenicity of 3 COVID-19 Messenger RNA Vaccine Doses in Patients With Inflammatory Bowel Disease. Inflammatory bowel diseases, 28(11), 1781–1786. https://doi.org/10.1093/ibd/izac082

    8. Ungaro, R. C., Brenner, E. J., Agrawal, M., Zhang, X., Kappelman, M. D., Colombel, J. F., & Surveillance Epidemiology of Coronavirus Under Research Exclusion for Inflammatory Bowel Disease (SECURE-IBD) Research Group (2022). Impact of Medications on COVID-19 Outcomes in Inflammatory Bowel Disease: Analysis of More Than 6000 Patients From an International Registry. Gastroenterology, 162(1), 316–319.e5. https://doi.org/10.1053/j.gastro.2021.09.011