SARS-CoV-2 vaccine & IBD

October 5, 2021

Issue 19

Clinical Question

How effective are SARS-CoV-2 vaccines in IBD patients?

Editor’s Bottom Line

SARS-CoV-2 is effective among patients with IBD, and its efficacy is not compromised by IBD therapy.

Reference

Lewis JD, Sandler RS, Brotherton C, et al. Effectiveness of SARS-CoV-2 Vaccination in a Veterans Affairs Cohort of Patients with Inflammatory Bowel Disease with Diverse Exposure to Immunosuppressive Medications. Gastroenterol. 2021;161(3):827–36; https://doi.org/10.1053/j.gastro.2021.05.044

Synopsis

This retrospective study included 14,697 patients with IBD treated at the Veterans Health Administration, 7,321 of whom had received at least one dose of an mRNA SARS-CoV-2 vaccine. Roughly 55% of vaccinated and unvaccinated patients were receiving mesalamine at the time of vaccination, while approximately one-fifth in each group were receiving an anti-tumor necrosis factor (TNF) agent alone, 11% were administered a thiopurine, 4% were receiving combination treatment with an anti-TNF and an immunomodulator, and the remaining patients were receiving ustekinumab, vedolizumab, methotrexate, tofacitinib and/or corticosteroids.

Patients were a median age 68 years, 61.8% had ulcerative colitis and most were white males.

Over a median follow-up of 123 days until April 20, 2021, 1.3% of unvaccinated individuals experienced SARS-CoV-2 infection, compared to 0.2% of partially vaccinated individuals and 0.1% of fully vaccinated individuals. Full vaccination was found to be 80.4% effective by seven days after the second dose, leading to a 69% reduced risk of infection (Hazard Ratio, 0.31; 95% Confidence Interval, 0.17–0.56; p<0.001). The type of IBD medication used and vaccine type administered did not affect vaccine effectiveness.

Details

Study Design: Retrospective cohort

Funding: None

Allocation: Not applicable

Setting: Multicenter

Level of Evidence: 2b