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COVID-19 Vaccine Gets Strong Response in Some With Weak Immunity

Cedars-Sinai Study Shows 99% of Vaccinated Bowel Disease Patients Had Detectable Antibodies

Researchers at Cedars-Sinai found that patients with inflammatory bowel disease (IBD)─whose treatment can weaken the immune system─produced a strong antibody response to COVID-19 vaccination. The study findings have been published in the Annals of Internal Medicine.

“At eight weeks, following completion of a two-dose mRNA vaccine series, 99% of patients had detectable antibodies from the vaccine irrespective of whether or not they were receiving immunocompromising therapies,” said Gil Melmed, MD, co-principal investigator of the study and director of Inflammatory Bowel Disease Clinical Research at Cedars-Sinai.

“This finding contrasts with the different immune-modifying medications taken by transplant recipients to prevent organ rejection, or cancer patients receiving chemotherapy, who have much lower rates of antibody response after COVID-19 mRNA vaccination and are at risk of not being protected as a result,” said Melmed, the lead author of the study.

An abnormal response to an infection or invading pathogen can sometimes cause the immune system to attack a person’s organs, producing harmful levels of inflammation. IBD refers to a class of disorders that result in chronic, and often destructive, inflammation of the digestive tract. Ulcerative colitis and Crohn’s disease are the two forms of IBD.

Researchers also found that at a certain point after the second vaccine dose, the antibody response of the IBD patients in the study differed and was associated with the kind of immunosuppressive medications they were taking.

“After eight weeks, we noted lower antibody levels in patients receiving anti-TNF(tumor necrosis factor) therapies or corticosteroids compared to patients treated with the immune-response blocking drugs anti-tegrin,anti-IL12/23,” said Dermot McGovern, MD, PhD, co-principal investigator of the study and director of Translational Research in the Inflammatory Bowel and Immunobiology Research Institute at Cedars-Sinai.

“However, these findings should still reassure IBD patients─and the millions of people who use these types of immunosuppressive medications─that the immediate response to mRNA vaccines against SARS-CoV-2, the virus that causes COVID-19, is good and on par with IBD patients who are not taking any drug therapies. Even so, patients receiving anti-TNF therapy or corticosteroids may be the ones most likely to benefit from a third dose of the vaccine,” said McGovern, the Joshua L. and Lisa Z. Greer Chair in Inflammatory Bowel Disease Genetics.

Researchers also noted the antibody response to vaccination in the IBD patients studied was similar to the response in non-immunosuppressed patients.

“They were well within the ‘positive’ range, meaning those patients on immunosuppressing medications also have a substantial amount of circulating antibody still present at the two-month mark. There is also data showing a correlation between that eight-week antibody level in vaccinated people and effective immunity in the community at large,” said study co-author Susan Cheng, MD, director of Public Health Research and the Erika J. Glazer Chair in Women's Cardiovascular Health and Population Science at Cedars-Sinai. 

Study investigators are now looking into other aspects of vaccine response in IBD patients that more directly correlates with protection from infection, like T-cell functional and neutralizing antibody responses.

“The results of our first look at COVID-19 vaccination response should be reassuring to our immunosuppressed patients with IBD,” said Melmed.

“‘Immunosuppressed’ patients are often portrayed as a homogenous high-risk group. Our study shows that while there may be differences based on medication types, almost all IBD patients have positive responses to the mRNA vaccine.”

Funding: This study was supported by The Leona M. and Harry B. Helmsley Charitable Trust, the Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, and the National Institute of Diabetes and Digestive and Kidney Disease Grants P01DK046763 and U01DK062413. This study has been additionally supported in part by the Cedars-Sinai Precision Health Initiative, the Erika J. Glazer Family Foundation, and through the Serological Sciences Network, grant NCI U54-CA260591.

Financial disclosures: Dermot McGovern and Gil Melmed are consultants for Pfizer Inc. related to IBD therapeutics; Melmed has received research funding from Pfizer for an unrelated investigator-initiated study. 

Read more on the Cedars-Sinai Blog: What IBD Patients Should Know About COVID-19