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expert reaction to study looking at antibody response to COVID-19 vaccine in patients with Inflammatory Bowel Disease who take the medicine infliximab

A study published in Gut looks at antibody response to vaccination with the Pfizer-BioNTech or Oxford-AstraZeneca COVID-19 vaccine in Inflammatory Bowel Disease (IBD) patients treated with infliximab, an anti-tumour necrosis factor (anti-TNF) biologic drug.


Prof Eleanor Riley, Professor of Immunology and Infectious Disease, University of Edinburgh, said:

“This study is a “bad news/good news” story. The “bad” news is that a commonly used immunotherapy for inflammatory bowel disease blunts the immune response to the first dose of COVID-19 vaccine. The “good” news is that the response to the second dose of the vaccine is much stronger with the vast majority of patients making a very strong antibody response.

“It is inevitable that any drug that targets a key mediator of the early immune response, such as infliximab, will have broad immunological effects including on susceptibility to infection and vaccine responses. Patients taking these drugs are well aware of these side effects. The comparison of infliximab with an alternative IBD therapy, vedolizumab, is interesting as vedolizumab is much more focussed in its actions, targeting just the gut itself. However, deciding on optimal treatment for IBD needs to take into account individual circumstances and long-term disease trajectory. On the basis of this data, the delayed but ultimately successful  response to COVID-19 vaccine in those receiving infliximab would not, in itself, appear to justify any change in treatment

“This study reinforces the message that  people should not assume that a single dose of vaccine will give them high levels of long lasting immunity. Whatever ones’ health status, it is vital to get the second dose of vaccine to maximise your levels of protection.”


Prof Daniel Altmann, Professor of Immunology, Department of Immunology and Inflammation, Imperial College London, said:

“This is among the first of the large-scale studies of vaccine roll-out in the real-world setting of immune-suppressed people – in this case, people with IBD taking the common anti-TNF drug, Infliximab.  It is also used by many with arthritis.  We’re used to the message that, on average, for most people, even one dose of vaccine offers considerable protection against symptomatic or severe infection.  However, in the real-world, people are complex.  The answer here is that around a third of patients with Inflammatory Bowel Disease who are taking infliximab don’t develop antibodies after one vaccine dose at a level likely to be protective.  While it’s great that so many people in the UK have received one vaccine dose, examples such as this are a reminder not to be complacent and to press on to the second vaccine dose.  Many other studies are in the pipeline to consider other groups of immune suppressed patients and vaccine responses.”



‘Infliximab is associated with attenuated immunogenicity to BNT162b2 and ChAdOx1 nCoV-19 SARS-CoV-2 vaccines in patients with IBD’ by Nicholas A Kennedy et al. was published in Gut.

DOI: 10.1136/gutjnl-2021-324789



Declared interests

Prof Eleanor Riley: “No COIs to declare.”

Prof Daniel Altmann: “Altmann collaborates with Prof Powell and the Clarity Study but was not involved in this part of the work.

Altmann has received payment for consultancy work with Oxford Immunotec.”

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