Which IBD Patients Experience More Severe COVID?

Some vaccinated inflammatory bowel disease (IBD) patients tended to get sicker during COVID-19 infections, research found.

Among 141 partially or fully vaccinated IBD patients who had COVID-19 infections, hospitalizations occurred among 8.5%, according to Emily Spiera, a medical student at the Icahn School of Medicine at Mount Sinai in New York City.

While not reaching significance, hospitalization rates trended numerically higher for those who:

• Had incomplete COVID-19 vaccinations (13.2% vs 5.7% with complete vaccination)
• Received non-mRNA vaccines (22.7% with adenovirus-vector vs 16.7% with inactivated virus vs 4.7% with mRNA vaccines)
• Were on immunomodulators (27.3%) or combination therapy (10.0%) in lieu of biologic monotherapy (4.2%)

"Our findings supported prior studies showing combination therapy and TNF [tumor necrosis factor] antagonists may result in reduced immunity and is also consistent with trends that mRNA vaccines may provide better protection in this patient population," Spiera said at the virtual Crohn's & Colitis Congress.

The only death among the vaccinated was in a patient receiving the AstraZeneca adenovirus-vector vaccine, Spiera said, referring to a woman, age 63, with moderately active Crohn's disease who died from a GI bleed after treatment with corticosteroids, adalimumab (Humira), and azathioprine during her COVID-19 infection.

For the vaccinated, the endpoints of severe COVID-19 infection (composite of intensive care unit admission, mechanical ventilation, or death) or death alone reached 2.8% and 0.7%, respectively, which were numerically lower than the 1.9% and 1.2% observed in a separate cohort of 2,317 unvaccinated peers. The unvaccinated group had a 9.3% hospitalization rate after infection.

"These data emphasize the importance of completing the vaccine series," said Dana Lukin, MD, of Weill Cornell Medicine in New York City, who was not involved in the study. He explained that the data suggest the importance of boosters to minimize breakthrough infections, and "if a choice of vaccine is present, mRNA vaccines may be more effective."

From the international Surveillance Epidemiology of Coronavirus Under Research Exclusion in Inflammatory Bowel Disease (SECURE-IBD) database, Spiera and colleagues found 88 IBD patients who completed primary vaccination at the time of SARS-CoV-2 infection, and another 53 who were partially vaccinated.

Those vaccinated or partially vaccinated with adenovirus vector (i.e., AstraZeneca, CanSino, Sputnik, or Janssen), mRNA (Moderna or Pfizer), or inactivated SARS-CoV-2 vaccines (Sinovac) before receiving a SARS-CoV-2 diagnosis were included.

Patients averaged 44 years old and were roughly split between the sexes. White people constituted the majority, with Hispanic patients accounting for 20%.

Nearly three-quarters took biologics, one-third used immunomodulators, and about 5% were on corticosteroids, according to Spiera. Two-thirds of the cohort had Crohn's disease.

Three in four people had received either Pfizer or Moderna COVID-19 vaccines. Hospitalizations were a relatively low 2.9% for those fully vaccinated with an mRNA series.

Four developed severe COVID-19 infection. Of those, three were on azathioprine, two were on TNF antagonists, and one was a chronic lung disease patient.

"None of our observations reached statistical significance, likely due to small sample size and low event numbers," Spiera cautioned.

The authors acknowledged several other limitations to the study, including potential reporting bias of patients with more severe illness. They were also only able to look at patients' medications during time of infection.

Moreover, the SECURE-IBD registry only includes patients with known SARS-CoV-2 infection, and results were found prior to the rise of the Omicron variant.

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