People with IBD can be reassured by findings from Israel’s highly vaccinated population that Pfizer’s COVID-19 vaccine has “excellent” and “comparable” effectiveness in IBD patients compared to the general population.
Findings published in Gastroenterology are based on an analysis of vaccine efficacy in 12,231 IBD patients and 36,254 matched patients who received the Pfizer Cominarty mRNA vaccination vaccine between December 2020 and March 2021.
Breakthrough infection rates at seven days post vaccination were 0.19% and 0.15% (RR: 1.21, 95% CI: 0.74–1.97) in IBD patients and healthy matched controls respectively.
At 14 days post second dose the infection rates were 0.14% and 0.10% respectively (RR: 1.26, 95% CI: 0.71–2.23).
Of 23 IBD patients who tested positive for COVID-19 at seven days post second dose, nine had symptoms, two were hospitalised and one died, the study reported.
The study showed a trend for Crohn’s disease patients to have a higher risk of breakthrough infection versus the matched population (P = 0.055), though no difference was observed for ulcerative colitis patients (P = 0.310).
As patients with immune conditions including IBD were excluded from the COVID-19 vaccine clinical trials, it was important to look at the protection shown in real world data, the study authors said.
They noted that the International Organization for the Study of Inflammatory Bowel Disease (IOI) has stated that mRNA vaccines are “safe to administer to patients with IBD” and should not be deferred due to immunomodulatory therapies, although, patients should be counselled that the vaccine’s efficacy may be decreased while receiving systemic corticosteroids.
With Israel having high population uptake of Pfizer vaccination (64% fully vaccinated), this provided a large cohort to examine the effects in patients with IBD, many of whom would be taking immunomodulatory therapy, the investigators said.
“No increased risk was demonstrated for patients treated with immune-modifying therapies,” they reported.
“In conclusion, to the best of our knowledge, this is the one of the first reports of real-world COVID-19 vaccine effectiveness in patients with IBD. Overall vaccine effectiveness was excellent and comparable to the reference population,” they concluded.
Currently both Pfizer and AstraZeneca vaccines are recommended as effective for for people with IBD on immunosuppressive therapy, according to GESA advice.
They state that some immunosuppressive medications may decrease how well the COVID-19 vaccine works, so the timing of vaccination should be discussed with patients taking more than 10mg of prednisolone daily or rituximab.