P040 Reduced serological response to COVID-19 vaccines in patients with IBD is further diminished by TNF inhibitor therapy; Early results of the VARIATION study (VAriability in Response in IBD Against SARS-COV-2 ImmunisatiON)

Doherty, J.(1);Stack, R.(1);O' Morain, N.(1);Girod, P.(1);Tosetto, M.(1);Inzitari, R.(2);Sheridan, J.(1);Cullen, G.(1);Buckley, M.(3);Mulcahy, H.(1);Ryan, E.J.(4);Daghfal, D.(5);Doran, P.(2);O Morain, C.(6);Doherty, G.(1);

(1)Centre for Colorectal Disease- St Vincent's University Hospital, Gastroenterology, Dublin, Ireland;(2)School of Medicine- University College Dublin, School of Medicine- University College Dublin, Dublin, Ireland;(3)St Michaels Hospital- Dun Laoighre, Gastroenterology, Dublin, Ireland;(4)University of Limerick, Department of Biological Sciences- Health Research Institute, Limerick, Ireland;(5)Abbot Diagnostics, Lake Forest, Illinois, United States;(6)Beacon Hospital, Gastroenterology, Dublin, Ireland; INITIative IBD research network (www.initiativeibd.ie)


Patients with inflammatory bowel disease (IBD) have attenuated responses to current vaccinations. There is a limited body of evidence suggesting patients with IBD receiving TNF antagonists have an attenuated response to vaccination against COVID-19. We sought to determine the impact of IBD and various medications for the treatment of IBD on antibody responses to vaccination against COVID-19.


Patients with IBD (n=270) and healthy controls (HC, n=116) were recruited prospectively and quantitative antibody responses were assessed following 1st and 2nd doses of COVID-19 vaccination. The impact of IBD and medications for treatment of IBD on vaccine response rates was investigated.


All HC seroconverted post complete vaccination [100%]. A small proportion of patients with IBD failed to seroconvert [2%]. Median IgG spike protein (SP) antibody levels post-complete vaccination in our IBD cohort was significantly lower than HC [2,613 AU/mL versus 6,871 AU/mL, p=<0.001]. A diagnosis of IBD and viral-vector vaccine use were independently associated with lower IgG SP antibody levels. Patients with IBD receiving anti-TNF therapy had significantly lower IgG SP antibody levels [2444.6 AU/mL] than IBD patients not receiving these agents [3867.6 AU/mL]. Patients with IBD not receiving TNF inhibitors still showed attenuated responses compared to HC receiving a similar vaccine [p = < 0.001].[Figure 1]. IgG SP antibody levels in our IBD cohort reduced rapidly during follow up.Figure 1: Difference in IgG levels in IBD patients on anti-TNF therapy, not receiving anti-TNF therapy and healthy controls who only received m RNA vaccines.


Patients with IBD who do not seroconvert post-vaccination against COVID-19 are a vulnerable cohort. Patient with IBD have attenuated serological responses to SARS-CoV-2 vaccination. Use of anti-TNF therapy further impacts IgG SP antibody levels. Impaired response to vaccination in our study highlights the importance of booster vaccination programmes for patients with IBD.