Infectious Disease

Corticosteroids make the COVID-19 vaccine less effective in IBD

September 03, 2021

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Rubin D. What an extra dose of the COVID-19 vaccine means for patients with IBD. Presented at: ACG Virtual Grand Rounds 2021. August 31 (virtual meeting).

Disclosure:
Rubin Reports has support from AbbVie, Bristol Myers Squibb, Janssen, Lilly, Pfizer and Takeda.

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Although COVID-19 infection rates do not differ significantly in patients with inflammatory bowel disease compared to the general population, some IBD therapies correlated with increased infection severity.

“The therapies for IBD are predominantly immune-based, immune-modifying and sometimes immunosuppressive”, David T. Rubin, MD, FACG, University of Chicago said at the ACG Virtual Grand Rounds 2021. “There is growing concern and apprehension that therapies for IBD could increase the risk of severe COVID-19 outcomes or interfere with vaccination response. In addition, CDC and FDA information is not specific to IBD and therefore confusing. “

Ruby quote

Overall, information from studies showed that patients with IBD are not at increased risk of infection, hospitalization, or death; However, these patients do not have a reduced risk either, added Rubin. Comorbidities such as age and weight continue to play a role in immunocompromised and immunocompetent patients.

“The International Organization for the Study of IBD has issued a number of consensus guidelines throughout the process,” said Rubin. “One published earlier this year (Siegel C, et al. Gut. 2021) made the following suggestions that now support the data: Patients with IBD should be vaccinated against SARS-CoV-2 and the best time to give the vaccine is for the earliest opportunity. “

In addition, current study data support initial analyzes that while steroids are associated with an increased risk of severe COVID-19, as measured by hospitalization, use of mechanical ventilation, and death, biological therapy (i.e., anti-tumor necrosis factor) is associated with a reduced risk for severe infection and could actually be protective. Rubin noted that vaccinated patients taking corticosteroids should be advised about the effectiveness of the vaccine.

In general, response rates after two doses of the FDA-marked COVID-19 vaccine in patients with IBD were similar to those in the general population. However, the PREVENT-COVID study (Kappelman et al. Gastroenterology. 2021) showed no significant decrease in antibody titers over time, suggesting the need for a booster dose, if any. The main difference between needing a third dose and a booster dose is that the third dose is only needed in patients who did not respond adequately to the first two doses, while the booster dose is intended to stimulate immune memory.

“Most patients with IBD are not considered to be immunocompromised and should not need an additional dose right now,” concluded Rubin. “When it’s time for a booster, everyone should get one, but that hasn’t been recommended or approved by the FDA yet.”

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