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Antibody decay, T cell immunity and breakthrough infections following two SARS-CoV-2 vaccine doses in inflammatory bowel disease patients treated with infliximab and vedolizumab.
Lin, Simeng; Kennedy, Nicholas A; Saifuddin, Aamir; Sandoval, Diana Muñoz; Reynolds, Catherine J; Seoane, Rocio Castro; Kottoor, Sherine H; Pieper, Franziska P; Lin, Kai-Min; Butler, David K; Chanchlani, Neil; Nice, Rachel; Chee, Desmond; Bewshea, Claire; Janjua, Malik; McDonald, Timothy J; Sebastian, Shaji; Alexander, James L; Constable, Laura; Lee, James C; Murray, Charles D; Hart, Ailsa L; Irving, Peter M; Jones, Gareth-Rhys; Kok, Klaartje B; Lamb, Christopher A; Lees, Charlie W; Altmann, Daniel M; Boyton, Rosemary J; Goodhand, James R; Powell, Nick; Ahmad, Tariq.
  • Lin S; Department of Gastroenterology, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK.
  • Kennedy NA; Exeter Inflammatory Bowel Disease and Pharmacogenetics Research Group, University of Exeter, Exeter, UK.
  • Saifuddin A; Department of Gastroenterology, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK.
  • Sandoval DM; Exeter Inflammatory Bowel Disease and Pharmacogenetics Research Group, University of Exeter, Exeter, UK.
  • Reynolds CJ; Department of Gastroenterology, St Marks Hospital and Academic Institute, London, UK.
  • Seoane RC; Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK.
  • Kottoor SH; Department of Infectious Disease, Imperial College London, London, UK.
  • Pieper FP; Department of Infectious Disease, Imperial College London, London, UK.
  • Lin KM; Department of Immunology and Inflammation, Imperial College London, London, United Kingdom.
  • Butler DK; Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK.
  • Chanchlani N; Department of Infectious Disease, Imperial College London, London, UK.
  • Nice R; Department of Infectious Disease, Imperial College London, London, UK.
  • Chee D; Department of Infectious Disease, Imperial College London, London, UK.
  • Bewshea C; Department of Gastroenterology, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK.
  • Janjua M; Exeter Inflammatory Bowel Disease and Pharmacogenetics Research Group, University of Exeter, Exeter, UK.
  • McDonald TJ; Exeter Inflammatory Bowel Disease and Pharmacogenetics Research Group, University of Exeter, Exeter, UK.
  • Sebastian S; Department of Biochemistry, Exeter Clinical Laboratory International, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK.
  • Alexander JL; Department of Gastroenterology, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK.
  • Constable L; Exeter Inflammatory Bowel Disease and Pharmacogenetics Research Group, University of Exeter, Exeter, UK.
  • Lee JC; Exeter Inflammatory Bowel Disease and Pharmacogenetics Research Group, University of Exeter, Exeter, UK.
  • Murray CD; Department of Gastroenterology, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK.
  • Hart AL; Exeter Inflammatory Bowel Disease and Pharmacogenetics Research Group, University of Exeter, Exeter, UK.
  • Irving PM; Department of Biochemistry, Exeter Clinical Laboratory International, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK.
  • Jones GR; IBD Unit, Department of Gastroenterology, Hull University Teaching Hospitals NHS Trust, Hull, UK.
  • Kok KB; Hull York Medical School, University of Hull, Hull, UK.
  • Lamb CA; Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK.
  • Lees CW; Department of Gastroenterology, Imperial College Healthcare NHS Trust, London, UK.
  • Altmann DM; Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK.
  • Boyton RJ; Department of Gastroenterology, Royal Free London NHS Foundation Trust, London, UK.
  • Goodhand JR; Genetic Mechanisms of Disease Laboratory, The Francis Crick Institute, London, UK.
  • Powell N; Cambridge Institute of Therapeutic Immunology and Infectious Disease, Jeffrey Cheah Biomedical Centre, Cambridge Biomedical Campus, University of Cambridge, Cambridge, UK.
  • Ahmad T; Department of Gastroenterology, Royal Free London NHS Foundation Trust, London, UK.
Nat Commun ; 13(1): 1379, 2022 03 16.
Article in English | MEDLINE | ID: covidwho-1747222
ABSTRACT
Anti tumour necrosis factor (anti-TNF) drugs increase the risk of serious respiratory infection and impair protective immunity following pneumococcal and influenza vaccination. Here we report SARS-CoV-2 vaccine-induced immune responses and breakthrough infections in patients with inflammatory bowel disease, who are treated either with the anti-TNF antibody, infliximab, or with vedolizumab targeting a gut-specific anti-integrin that does not impair systemic immunity. Geometric mean [SD] anti-S RBD antibody concentrations are lower and half-lives shorter in patients treated with infliximab than vedolizumab, following two doses of BNT162b2 (566.7 U/mL [6.2] vs 4555.3 U/mL [5.4], p <0.0001; 26.8 days [95% CI 26.2 - 27.5] vs 47.6 days [45.5 - 49.8], p <0.0001); similar results are also observed with ChAdOx1 nCoV-19 vaccination (184.7 U/mL [5.0] vs 784.0 U/mL [3.5], p <0.0001; 35.9 days [34.9 - 36.8] vs 58.0 days [55.0 - 61.3], p value < 0.0001). One fifth of patients fail to mount a T cell response in both treatment groups. Breakthrough SARS-CoV-2 infections are more frequent (5.8% (201/3441) vs 3.9% (66/1682), p = 0.0039) in patients treated with infliximab than vedolizumab, and the risk of breakthrough SARS-CoV-2 infection is predicted by peak anti-S RBD antibody concentration after two vaccine doses. Irrespective of the treatments, higher, more sustained antibody levels are observed in patients with a history of SARS-CoV-2 infection prior to vaccination. Our results thus suggest that adapted vaccination schedules may be required to induce immunity in at-risk, anti-TNF-treated patients.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Viral Vaccines / Inflammatory Bowel Diseases / COVID-19 Type of study: Prognostic study / Randomized controlled trials Topics: Vaccines Limits: Humans Language: English Journal: Nat Commun Journal subject: Biology / Science Year: 2022 Document Type: Article Affiliation country: S41467-022-28517-z

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Viral Vaccines / Inflammatory Bowel Diseases / COVID-19 Type of study: Prognostic study / Randomized controlled trials Topics: Vaccines Limits: Humans Language: English Journal: Nat Commun Journal subject: Biology / Science Year: 2022 Document Type: Article Affiliation country: S41467-022-28517-z