SARS-CoV-2 breakthrough infections after COVID-19 vaccination in patients with inflammatory bowel disease: a systematic review and meta-analysis.

IF 4.2 3区医学 Therapeutic Advances in Gastroenterology Pub Date : 2023-07-15 eCollection Date: 2023-01-01 DOI:10.1177/17562848231174295

Natasja van de Pol, Qiuwei Pan, Lauranne A A P Derikx, Linda Bakker, C Janneke van der Woude, Annemarie C de Vries

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Abstract

Background: Patients with inflammatory bowel disease (IBD) have an attenuated serologic response to COVID-19 vaccination. It is unclear whether an impaired immune response in vaccinated IBD patients impacts the susceptibility to SARS-CoV-2 infection and occurrence of severe COVID-19.

Objectives: To evaluate SARS-CoV-2 breakthrough infection rates and the disease course of COVID-19 in vaccinated IBD patients.

Design: A systematic literature search and meta-analysis was performed.

Data sources and methods: The search was performed in Embase, Medline, Web of Science Core Collection, Cochrane Central Register of Controlled Trials and CINAHIL. The articles were independently screened and selected by two reviewers. A random-effects model was used to calculate the pooled relative risk for breakthrough infections in vaccinated IBD patients and controls.

Results: A total of 16 studies were included, with study periods ranging from January 2020 to October 2021 and follow-up time from 3 weeks to 6 months. The breakthrough infection rates range from 0 to 37.4% in vaccinated IBD patients. The disease course of COVID-19 was generally mild, with low hospitalization and mortality rates (0-8.7% and 0-4.3%, respectively). Vaccinated IBD patients had a significantly lower relative risk of breakthrough infection rate compared to unvaccinated controls (risk ratio: 0.07, 95% CI: 0.03-0.18). No difference was observed between IBD patients and non-IBD controls, and between partially and fully vaccinated IBD patients. The impact of immunosuppressive therapy on breakthrough infection rates differs between studies. Most studies showed no impact from immunosuppressive treatment, anti-tumour necrosis factor alpha or corticosteroids and other biologics; one study reported higher rates for patients treated with infliximab versus vedolizumab.

Conclusion: Vaccination is effective to prevent COVID-19 infections in patients with IBD. Breakthrough infections do occur, but the disease course is generally mild. Available data seem to suggest a declining trend of breakthrough infections during calendar time.

Registration: The protocol was published in the PROSPERO database (CRD42021292853).

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炎症性肠病患者接种 COVID-19 疫苗后的 SARS-CoV-2 突破性感染：系统回顾和荟萃分析。

背景：炎症性肠病（IBD）患者对接种 COVID-19 疫苗的血清反应减弱。目前还不清楚接种过疫苗的 IBD 患者的免疫反应减弱是否会影响 SARS-CoV-2 感染的易感性和严重 COVID-19 的发生：评估接种疫苗的 IBD 患者的 SARS-CoV-2 突破性感染率和 COVID-19 的病程：设计：进行了系统的文献检索和荟萃分析：在 Embase、Medline、Web of Science Core Collection、Cochrane Central Register of Controlled Trials 和 CINAHIL 中进行了检索。文章由两名审稿人独立筛选。采用随机效应模型计算接种疫苗的 IBD 患者和对照组发生突破性感染的汇总相对风险：共纳入 16 项研究，研究时间为 2020 年 1 月至 2021 年 10 月，随访时间为 3 周至 6 个月。接种疫苗的 IBD 患者的突破性感染率从 0% 到 37.4% 不等。COVID-19 的病程一般较轻，住院率和死亡率较低（分别为 0-8.7% 和 0-4.3%）。与未接种疫苗的对照组相比，接种疫苗的 IBD 患者的突破性感染率相对风险明显较低（风险比：0.07，95% CI：0.03-0.18）。在 IBD 患者和非 IBD 对照组之间，以及在部分接种和完全接种疫苗的 IBD 患者之间，均未观察到差异。免疫抑制疗法对突破性感染率的影响因研究而异。大多数研究显示，免疫抑制治疗、抗肿瘤坏死因子α或皮质类固醇及其他生物制剂对突破性感染率没有影响；一项研究报告称，使用英夫利昔单抗治疗的患者的感染率高于使用维度珠单抗治疗的患者：结论：接种疫苗可有效预防 IBD 患者感染 COVID-19。结论：接种疫苗可有效预防 IBD 患者感染 COVID-19，突破性感染确实会发生，但病程一般较轻。现有数据似乎表明，突破性感染在历时内呈下降趋势：该方案已在 PROSPERO 数据库（CRD42021292853）中公布。

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来源期刊

Therapeutic Advances in Gastroenterology Medicine-Gastroenterology

自引率

2.40%

发文量

103

期刊介绍： Therapeutic Advances in Gastroenterology is an open access journal which delivers the highest quality peer-reviewed original research articles, reviews, and scholarly comment on pioneering efforts and innovative studies in the medical treatment of gastrointestinal and hepatic disorders. The journal has a strong clinical and pharmacological focus and is aimed at an international audience of clinicians and researchers in gastroenterology and related disciplines, providing an online forum for rapid dissemination of recent research and perspectives in this area. The editors welcome original research articles across all areas of gastroenterology and hepatology. The journal publishes original research articles and review articles primarily. Original research manuscripts may include laboratory, animal or human/clinical studies – all phases. Letters to the Editor and Case Reports will also be considered.