COVID-19 vaccine efficacy in IBD

COVID-19 vaccine efficacy in IBD

April 12, 2022

Issue 07

Clinical Question

Do IBD treatments reduce COVID-19 vaccine response?

Editor’s Bottom Line

Anti-TNF therapies may reduce serologic responses to COVID-19 vaccines, but it is not yet clear whether this translates to an increased risk of subsequent SARS-CoV-2 infection. COVID-19 vaccines are well-tolerated by patients with IBD.


Edelman-Klapper H, Zittan E, Bar-Gil Shitrit A, et al. Lower Serologic Response to COVID-19 mRNA Vaccine in Patients With Inflammatory Bowel Diseases Treated With Anti-TNFα. Gastroenterol. 2022;162(2):454–67;


Israeli researchers prospectively enrolled 185 patients with IBD and 73 healthy controls to receive two doses of the mRNA COVID-19 vaccine, BNT162b2 (Comirnaty; Pfizer/BioNTech). Participants were evaluated before the first dose, 2–3 weeks after the first dose, one week after the second dose, which was administered a median 21 days after the first dose, and then 3–5 weeks after the second dose. Vaccine response, adverse events and changes in IBD activity were measured. Sixty-seven IBD patients were receiving an anti-tumor necrosis factor (TNF) agent at the time of vaccination, while other IBD patients were receiving non-anti-TNF biologics, 5-ASA, immunomodulators, corticosteroids or no medical treatment.

While all healthy controls produced SARS-CoV-2 anti-spike immunoglobulin G (IgG) antibodies after the first dose, approximately 7% of patients with IBD had no serological response with one dose. Some of these patients were not receiving medical treatment at the time.

All IBD patients were seropositive after the second dose, however anti-spike IgG antibody titers were 2–3 times lower among IBD patients receiving anti-TNF agents compared to both healthy controls and IBD patients not receiving an anti-TNF agent (p<0.001). Those receiving an anti-TNF drug also had a significantly lower SARS-CoV-2 infection neutralization capacity one week after the second dose, compared to both healthy controls and IBD patients not receiving an anti-TNF (p<0.0001 for anti-TNF recipients compared to non-anti-TNF recipients and healthy controls). The authors found no correlation between anti-TNF drug levels and serologic vaccine response.

Multivariate analysis showed that anti-TNF treatment and older age were independently associated with lower IgG anti-spike protein response after the first and second doses (p<0.001).

Approximately 2% of IBD patients and healthy controls experienced COVID-19 infection during follow-up and all were asymptomatic. IBD treatment type did not affect infection status.

There were no differences in vaccine-related adverse events between groups and vaccination did not increase the risk of IBD exacerbation.


Study Design: Prospective, controlled

Funding: The Leona M. and Harry B. Helmsley Charitable Trust, the Crohn’s and Colitis Foundation of Israel and the European Federation of Crohn’s and Colitis Associations.

Allocation: Not applicable

Setting: Multicenter

Level of Evidence: 1b