Serological Responses to the First Three Doses of SARS-CoV-2 Vaccination in Inflammatory Bowel Disease: A Prospective Cohort Study

  1. Joshua Quan
  2. Christopher Ma
  3. Remo Panaccione
  4. Lindsay Hracs
  5. Nastaran Sharifi
  6. Michelle Herauf
  7. Ante Markovinović
  8. Stephanie Coward
  9. Joseph W. Windsor
  10. Léa Caplan
  11. Richard J. M. Ingram
  12. Jamil N. Kanji
  13. Graham Tipples
  14. Jessalyn K. Holodinsky
  15. Charles N. Bernstein
  16. Douglas J. Mahoney
  17. Sasha Bernatsky
  18. Eric I. Benchimol
  19. Gilaad G. Kaplan
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Abstract

Background

Individuals with inflammatory bowel disease (IBD) who are immunocompromised may have a reduced serological response to the SARS-CoV-2 vaccine. We investigated serological responses following 1 st , 2 nd , and 3 rd doses of SARS-CoV-2 vaccination in those with IBD.

Methods

A prospective cohort study of persons with IBD ( n = 496) assessed serological response 1–8 weeks after 1 st dose vaccination, 1–8 weeks after 2 nd dose, 8 or more weeks after 2 nd dose, and at least 1 week after 3 rd dose. Seroconversion and geometric mean titer (GMT) with 95% confidence intervals (CI) were assessed for antibodies to the SARS-CoV-2 spike protein. Multivariable linear regression models assessed the adjusted fold change (FC) in antibody levels.

Results

Seroconversion and GMT increased from post-1 st dose to 1–8 weeks post-2 nd dose (81.6%, 1814 AU/mL vs. 98.7%, 9229 AU/mL, p <0.001), decreased after 8 weeks post-2 nd dose (94.9%, 3002 AU/mL, p <0.001), and rebounded post-3 rd dose (99.6%, 14639 AU/mL, p <0.001). Prednisone was the only IBD-related medication associated with diminished antibody response after 3 rd -dose vaccination (FC: 0.07 [95% CI: 0.02, 0.20]). Antibody levels steadily decline following the 2 nd (FC: 0.92 [95% CI: 0.90, 0.94] per week) and 3 rd dose (FC: 0.88 [95% CI: 0.84, 0.92] per week) of the SARS-CoV-2 vaccine.

Conclusion

A three-dose regimen of vaccination to SARS-CoV-2 yields a robust antibody response for those with IBD across all classes of IBD therapies except for prednisone. The decaying antibody levels following the 3 rd dose of the vaccine should be monitored in future studies.

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