People who live with inflammatory bowel disease (IBD) have questions regarding COVID-19 vaccination and how it may be impacted by their disease or their medications. IBDologists recommend that people who live with Crohn’s disease or ulcerative colitis receive a vaccination for COVID-19. Check with your physicians on your individual circumstances but, in general, the advice is that the vaccines are safe and effective for people with IBD, and they are recommended.
In fact: vaccination is encouraged for people with IBD. Speaking for myself, I have enough problems, and I don’t need to add the risk of developing COVID-19 to them. For that reason, I scheduled my vaccination appointment as soon as I was eligible in my state.
My Interview With a Noted IBDologist on COVID-19 Vaccines
But Maybe Show Me Some Data?
However, because IBD patients are smart, we all want data on how well the vaccines will protect us. Before having any data, vaccination was still recommended because some immunity is still better than none. The COVID-19 vaccines are more effective than many other vaccines we already receive on a regular basis. Even if there is a blip and efficacy is slightly lowered in people who are receiving certain types of medications: the effectiveness is still going to be helpful in protecting oneself, loved ones, and the larger community.
A pre-print study has come out that offers some data on the effectiveness of two of the vaccines: SARS-CoV-2 spike (S) mRNA BNT162b2 (Pfizer-BioNTech) and mRNA-1273 (NIH-Moderna). Pre-print means that this paper has not yet been peer-reviewed. Peer review is an important step in the publication process and it can (and often does) result in some changes being made to the final paper. Basically, some specialists who are not involved with the study look at all the data and try to poke holes in it. It’s a really good thing.
Even so: we can look at the takeaways from this study and put it in our pockets as we make decisions about vaccination against COVID-19.
Patients with IBD were not included in the trials for the COVID-19 vaccines. While that makes sense, it’s also a bummer for us. So, data are going to start coming out now that look at how our bodies might respond and the number of patients are going to be a bit small until more of us get vaccinated.
Medications Used By Patients in This Study
There were 48 patients in this study. They received 1 or 2 doses of either the Pfizer or the Moderna COVID-19 vaccines. Their blood was tested for SARS-CoV-2 (the virus that causes COVID-19) immunoglobulins. These are antibodies against the virus. The body can make them after either being infected with SARS-CoV-2 or after receiving a vaccine. When you have antibodies to a virus, you can fight it off and perhaps not get sick (or not get as sick as you have would without them).
Some of the patients in this group were receiving various medications for their IBD. Here’s the breakdown:
- 85% (41/48), were receiving biologics:
- 33% (16 patients) on TNF medication alone (this could include Remicade, Inflectra, or Humira)
- 42% (17 patients) on Entyvio (vedolizumab) alone
- 6% (3 patients) on Entyvio and a thiopurine (this could include azathioprine or mercaptopurine)
- 8% (4 patients) on Stelara (ustekinumab)
- 1 patient on Tremfya (guselkumab) for psoriasis
- 6% (3 patients) on oral steroids (such as prednisone)
Now, here’s a quote from this study and after I’ll provide an explanation:
“IBD patients receiving biologics can seroconvert with robust serological responses after complete Pfizer-BioNTech and NIH-Moderna COVID-19 vaccination. In IBD-patients with previous SARS-CoV-2 seroconversion, a single dose of either vaccine can induce high index values, mirroring findings from the general population.”Wong SY, et al. Preprint. Posted online March 20, 2021. medRxiv 2021.03.17.21253848. doi:10.1101/2021.03.17.21253848.
What the authors are saying here is that people with IBD in this study who were on the drugs mentioned above had a good response (“robust”) to the vaccines. They tested the blood of patients after vaccination and found antibodies to the novel coronavirus. This happened with even only one dose of a vaccine (both of the vaccines in the study require two doses for full effect). The authors say that these patients with IBD had about the same level of antibodies as people who don’t have IBD.
This is a small study, and it doesn’t cover every possible scenario: but it is still really good news!
A Blip With Entyvio That’s Not Understood Yet
Now, here’s where the results get a bit tricky to draw conclusions. Here’s another quote:
“We also found an association of lower antibody levels in patients with vedolizumab. This finding is of unclear clinical significance and warrants further investigation, as this result could have been affected by timing, vaccine, or clinical characteristics such as age.”Wong SY, et al. Preprint. Posted online March 20, 2021. medRxiv 2021.03.17.21253848. doi:10.1101/2021.03.17.21253848.
The patients who were receiving Entyvio (vedolizumab) had slightly lower levels of antibodies. Does this mean anything? We don’t yet know. There were only 17 patients, which is a small number, so we need to understand is there some other reason that could affect the results. For instance, does the brand of vaccine matter or the age of the patient or some other factor? We don’t know, but the vaccine will still be recommended for people who take Entyvio because (I know: I’m a broken record) some immunity is better than none.
Racial and Ethnic Makeup of Patients
Now let’s talk for a minute about the racial breakdown of the patients. There were 88% (42) who were white and 6 (12%) who were “non-white.” This doesn’t give us a lot to work with regarding the differences in how people of various ethnic and racial groups with IBD will respond to vaccination. Here’s where I have a quibble: patients are not only “white and non-white.” I can’t draw any conclusions as to the reasons behind the classification in this study but I would like to see a better discussion of racial and ethnic groups and vaccination status in the IBD community. Let’s do better.
And, even so: a vaccine against COVID-19 is still recommended for patients in all ethnic and racial groups. (Some vs none: you get it.)
Overall, This is Good News
I hope this breakdown of some of the points in this pre-print study are helpful and offer a measure of comfort: because it should! There will be much more to come as IBD patients receive their vaccines and offer up their arms for these types of studies.
Got questions about your specific situation with IBD and vaccination? Be sure to talk to your doctors!
Wong SY, Dixon R, Pazos VM, ICARUS-IBD Working Group, Gnjatic S, Colombel JF, Cadwell K. Serological response to COVID-19 vaccination in IBD patients receiving biologics. Preprint. Posted online March 20, 2021. medRxiv 2021.03.17.21253848. doi:10.1101/2021.03.17.21253848.
This article is a preprint and has not been certified by peer review. It reports new medical research that has yet to be evaluated and so should not be used to guide clinical practice.