ABSTRACT
Introduction: SARS-CoV-2 infection may lead to the development of the novel coronavirus disease (COVID-19). Scarce data is available regarding safety and efficacy of SARS-CoV-2 vaccination in IBD patients, which may present differences between subgroups. Lower immunological response could require an additional booster injection. Aims & Methods: Prospective study including adult patients with IBD after complete vaccination against SARS-COV-2 infection with BioNTech vaccine. Patients with previous SARS-COV-2 infection were excluded. A control group with healthy individuals matched for age and sex was also analyzed. Blood samples were collected 30 days after complete vaccination to quantify IgG antibody titers against SARS-CoV-2 in both groups. Result(s): Final sample included 81 IBD and 32 non-IBD patients, 55(48.7%) of them females, with a mean age of 40.2+/-13.0 years. From IBD patients, 58(71.6%) had CD and 23(28.4%) UC. IBD patients had significantly lower median anti-SARS-COV-2 IgG levels when compared to the control group (6479, IQR-10053 vs 13061, IQR-15539 AU/mL;p=0.003). Regarding IBD medication, significant lower levels of SARS-COV-2 IgG antibodies when compared to controls where observed in patients under thiopurines (5423, IQR-10260 AU/mL;p=0.011);methotrexate (834, IQR-4155 AU/mL;p=0.002);infliximab (5294, IQR-10392 AU/mL;p=0.001);and corticosteroids (548, IQR-n/a AU/mL;p=0.001). The incidence of SARS-CoV-2 infection after vaccination was also significantly higher in each of these treatments - healthy controls 25% vs thiopurines 50% (p=0.025), infliximab 43.8% (p=0.048), methotrexate 75% (p=0.041) and corticosteroids 100% (p=0.027). Conclusion(s): IBD patients under Immunomodulators, infliximab and corticosteroid treatment presented significantly lower anti-SARS-COV-2 IgG levels 30 days following complete vaccination when compared to healthy controls. These findings could support the benefit of an additional booster injection in this population.
ABSTRACT
Background: The severe acute respiratory syndrome coronavirus, 2 (SARS-COV-2) infection may lead to the development of the novel coronavirus disease, 2019 (COVID-19). Currently, little to no data is available regarding safety and efficacy of SARS-COV-2 vaccination in Inflammatory Bowel Disease (IBD) patients, which may present differences between subgroups, as these patients may exhibit impaired innate and adaptive immune system responses. Lower immunological response could, in this specific population, require an additional booster injection. Methods: We conducted a prospective study including adult patients with Crohn's disease (CD) and Ulcerative Colitis (UC) who have undergone complete vaccination against SARS-COV-2 infection with BioNTech® vaccine. Patients with previous SARS-COV-2 infection were excluded. Medical data regarding age, sex, IBD classification and current medication for IBD were collected. A control group with healthy individuals matched for age and sex was also analyzed. Blood samples were collected, 30 days after complete vaccination to quantify IgG antibody titers for SARS-COV-2 in both groups (IBD and non-IBD). Results: Our final sample included, 81 IBD and, 32 non-IBD patients, 55 (48.7%) of them females, with a mean age of, 40.2±13.0 years. From the IBD patients, 58(71.6%) had CD and, 23(28.4%) had UC. IBD patients had significantly lower anti-SARS-COV-2 IgG levels when compared to the control group (8950±9366 vs, 14834±11679 AU/mL;p=0.003). Regarding IBD medication, significant lower levels of SARS-COV-2 IgG antibodies when compared to control patients were found in patients under thiopurines (9074±9779 AU/mL;p=0.011);methotrexate (1987±2568 AU/mL;p=0.002);infliximab (7208±7276 AU/ mL;p=0.001);and corticosteroids (1065±933 AU/mL;p=0.001). Additionally, patients under combined therapy (infliximab plus thiopurines) presented with significantly lower antibodies titers when compared to patients treated with thiopurines in monotherapy (8130±11048 vs, 10563±5680 AU/mL;p=0.039). No significant differences were found in IBD patients under salicylates (10195±7371 AU/mL;p=0.226);adalimumab (15644±21467 AU/mL;p=0.336);vedolizumab (10464±9087 AU/mL;p=0.286) and ustekinumab (11366±10016 AU/mL;p=0.390). Conclusion: IBD patients presented with significantly lower anti- SARS-COV-2 IgG levels, 1 month after complete vaccination against SARS-COV-2 infection compared to healthy controls. Thiopurines, methotrexate, infliximab and corticosteroid treatment were associated with significantly lower antibodies levels. These findings may express the benefit of an additional booster injection in this population.
ABSTRACT
Introduction: More than 2.5 million people in Europe are diagnosed with inflammatory bowel diseases (IBD). IBD affects the quality of life, but also has important consequences for health systems. It remains unknown if variations in IBD care and education differs across Europe and to help address this question, we conducted this European Variation In IBD PracticE suRvey (VIPER) to study potential differences. Aims & Methods: This trainee-initiated survey, run through SurveyMonkey ®, consisted of 47 questions inquiring basic demographics, IBD training and clinical care. The survey was distributed through social media and national GI societies from December 2020 - January 2021. Results were compared according to GDP per capita, for which countries were divided into 2 groups (low/high income, according to the World Bank). Differences between groups were calculated using the chi2 statistic. Results: The online survey was completed by 1268 participants from 39 European countries. Most of the participants are specialists (65.3 %), followed by fellows in training (>/< 3 years, 19.1%, 15.6 %). Majority of the responders are working in academic institutions (50.4 %), others in public/ district hospitals (33.3 %) or private practices (16.3 %). Despite significant differences in access to IBD-specific training between high (56.4%) and low (38.5%) GDP countries (p<0.001), majority of clinicians feels comfortable in treating IBD (77.2% vs 72.0%, p=0.04). GDP was not a factor that dictated confidence in treating patients. IBD patients seen per week, IBD boards and especially IBD specific training were factors increasing confidence in managing IBD patients. Interestingly, a difference in availability of dedicated IBD units could be observed (58.5% vs 39.7%, p<0.001), as well as an inequality in multidisciplinary meetings (72.6% vs 40.2%, p<0.001), which often take place on a weekly basis (53.0%). In high GDP countries, IBD nurses are more common (86.2%) than in low GDP countries (36.0%, p<0.001), which is mirrored by differences in nurse-led IBD clinics (40.6% vs 13.8%, p<0.001). IBD dieticians (32.4% vs 16.6%) and psychologists (16.7% vs 7.5%) are mainly present in high GDP countries (p<0.001). In the current COVID era, telemedicine is available in 58.4% vs 21.4% of the high/low GDP countries respectively (p<0.001), as well as urgent flare clinics (58.6% vs 38.7%, p<0.001) and endoscopy within 24 hours if needed (83.0% vs 86.7% p=0.1). Treat-to-target approaches are implemented everywhere (85.0%), though access to biologicals and small molecules differs significantly. Almost all (94.7%) use faecal calprotectin for routine monitoring, whereas half also use intestinal ultrasound (47.9%). Conclusion: A lot of variability in IBD practice exists across Europe, with marked differences between high vs low GDP countries. Further work is required to help address some of these inequalities, aiming to improve and standardise IBD care across Europe.