Researchers Pinpoint Reason for Faster Waning of COVID-19 Vaccine Protection in Patients with IBD Treated with TNF-alpha Blockers

Tumor necrosis factor-alpha (TNF-alpha) blockers are biologics typically prescribed to treat various inflammatory autoimmune conditions, including ulcerative colitis. Specifically, Remicade (infliximab and biosimilars) and Humira (adalimumab and biosimilars) are FDA-approved to treat moderately to severely active ulcerative colitis.

Research has shown that patients with inflammatory bowel disease (IBD), including ulcerative colitis, treated with TNF-alpha blockers have a lower antibody response and a shorter duration of immunity than those who receive integrin receptor antagonists, such as Entyvio (vedolizumab), or no medication at all. In a study published earlier this month in the journal eBioMedicine (part of The Lancet), researchers from the Medical University of Vienna aimed to investigate the mechanisms causing this early wane in antibody levels and dampened immune response.

Lead author Erika Garner-Spitzer, M.Sc. Ph.D., and her colleagues analyzed antibody titers, induction of B memory cells, and distribution and activation of T follicular helper cell subsets in patients with IBD who had been treated with a TNF-alpha blocker, an integrin receptor antagonist, or no therapy. The study participants had received two doses and a booster of a mRNA COVID-19 vaccine, such as Comirnaty (Pfizer) or Spikevax (Moderna). Booster doses were administered six months after the second vaccine dose.

The researchers found that the reduced immune response and early waning of protection in patients treated with TNF-alpha blockers is due to a lack of activation of T follicular helper cell subsets and decreased B memory cell formation.

According to the authors, these study results suggest the need for vaccine schedules tailored for patients receiving TNF-alpha treatment and possibly repeated booster doses.