ClinGastroenterolHepatol. 2024Feb16:S15423565(24)002039.doi:10.1016/j.cgh.2024.02.001. Online ahead of print.

Erica J Brenner ¹, Kimberly N Weaver ², Xian Zhang ³, Arthur J Kastl ⁴, Jennifer A Strople ⁵, Jeremy Adler ⁶, Marla C Dubinsky ⁷, Athos Bousvaros ⁸, Runa Watkins ⁹, Xiangfeng Dai ¹⁰, Wenli Chen ¹⁰, Raymond K Cross ¹¹, Peter D R Higgins ¹², Ryan C Ungaro ¹³, Meenakshi Bewtra ¹⁴, Emanuelle A Bellaguarda ¹⁵, Francis A Farraye ¹⁶, Kelly Y Chun ¹⁷, Michael Zikry ¹⁷, Monique Bastidas ¹⁷, Ann Firestine ¹⁸, Riley G Craig ¹⁹, Margie E Boccieri ³, Millie D Long ¹⁹, Michael D Kappelman ³

Author information

¹Division of Pediatric Gastroenterology Department of Pediatrics University of North Carolina at Chapel Hill Chapel Hill, North Carolina Center for Gastrointestinal Biology and Disease University of North Carolina at Chapel Hill. Electronic address: Erica.Brenner@unchealth.unc.edu.

²Division of Gastroenterology, Hepatology, and Nutrition Allegheny Health Network Pittsburgh, PA, USA.

³Division of Pediatric Gastroenterology Department of Pediatrics University of North Carolina at Chapel Hill Chapel Hill, North Carolina Center for Gastrointestinal Biology and Disease University of North Carolina at Chapel Hill.

⁴Division of Gastroenterology, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.

⁵Division of Pediatric Gastroenterology, Hepatology and Nutrition, Ann & Robert H. Lurie Children's Hospital of Chicago, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.

⁶Susan B. Meister Child Health Evaluation and Research Center, Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA.

⁷Dr. Henry D. Janowitz Division of Gastroenterology Department of Pediatrics Icahn School of Medicine at Mount Sinai New York, New York.

⁸Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.

⁹Division of Pediatric Gastroenterology and Nutrition, University of Maryland School of Medicine, Baltimore, MD, USA.

¹⁰Center for Gastrointestinal Biology and Disease, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.

¹¹Division of Gastroenterology and Hepatology, University of Maryland School of Medicine, Baltimore, MD, USA.

¹²Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI, USA.

¹³Dr. Henry D. Janowitz Division of Gastroenterology Department of Medicine Icahn School of Medicine at Mount Sinai New York, New York.

¹⁴Division of Gastroenterology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, PA, USA.

¹⁵Division of Gastroenterology and Hepatology, Northwestern University, Chicago, IL, USA.

¹⁶Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL, USA.

¹⁷Research and Development, Labcorp Calabasas, CA, USA.

¹⁸Division of Pediatric Gastroenterology Department of Pediatrics University of North Carolina at Chapel Hill Chapel Hill, North Carolina.

¹⁹Division of Gastroenterology and Hepatology Department of Medicine University of North Carolina at Chapel Hill Multidisciplinary Center for Inflammatory Bowel Diseases University of North Carolina at Chapel Hill Chapel Hill, North Carolina.

Abstract

Background and aims: COVID-19 vaccination prevents severe disease in most patients with IBD, but immunosuppressive medications can blunt serologic response. We followed adults with IBD for >1-year post-COVID-19 vaccination to describe factors associated with SARS-CoV-2 infection after vaccination, evaluate for a protective SARS-CoV-2 antibody level, characterize SARS-CoV-2 antibody persistence, and identify factors associated with humoral immune response durability.

Methods: Using a prospective cohort of COVID-19 immunized adults with IBD, we analyzed factors associated with SARS-CoV-2 infection after vaccination. We evaluated for an association between SARS-CoV-2 antibody level 12 weeks post-vaccination and subsequent SARS-CoV-2 infection and assessed for a threshold of protection using receiver operating curve analysis. We then conducted a separate analysis evaluating factors associated with persistence of SARS-CoV-2 antibodies 52 weeks post-immunization.

Results: Almost half (43%) of 1,869 participants developed COVID-19 after vaccination, but most infections were mild and <1% required hospitalization. Older age and corticosteroid use were associated with a decreased risk of SARS-CoV-2 infection post-vaccination (ages 50-59 vs 18-29: adjusted hazard ratio [aHR] 0.57; 95% confidence interval [CI] 0.44-0.74; steroid users vs non-users: aHR 0.58; 95% CI 0.39-0.87). Most (98%) participants had detectable antibody levels at 52 weeks post-vaccination. Antibody levels at 12 weeks and number of vaccine doses were positively associated with higher antibody levels at 52 weeks, while anti-tumor necrosis factor (TNF) alpha therapy was negatively associated.

Conclusions: COVID-19 vaccination generates an effective and durable protective response for the vast majority of adults with IBD, including vulnerable populations such as corticosteroid users and older individuals. Patients with IBD benefit from COVID-19 booster vaccination.