Long-Term Effectiveness and Durability of COVID-19 Vaccination among Patients with Inflammatory Bowel Disease

Background and Aims COVID-19 vaccination prevents severe disease in most patients with IBD, but immunosuppressive medications can blunt serologic response. We followed adults with IBD for >1-year post-COVID-19 vaccination to describe factors associated with SARS-CoV-2 infection after vaccination, evaluate for a protective SARS-CoV-2 antibody level, characterize SARS-CoV-2 antibody persistence, and identify factors associated with humoral immune response durability. Methods Using a prospective cohort of COVID-19 immunized adults with IBD, we analyzed factors associated with SARS-CoV-2 infection after vaccination. We evaluated for an association between SARS-CoV-2 antibody level 12 weeks post-vaccination and subsequent SARS-CoV-2 infection and assessed for a threshold of protection using receiver operating curve analysis. We then conducted a separate analysis evaluating factors associated with persistence of SARS-CoV-2 antibodies 52 weeks post-immunization. Results Almost half (43%) of 1,869 participants developed COVID-19 after vaccination, but most infections were mild and <1% required hospitalization. Older age and corticosteroid use were associated with a decreased risk of SARS-CoV-2 infection post-vaccination (ages 50-59 vs 18-29: adjusted hazard ratio [aHR] 0.57; 95% confidence interval [CI] 0.44-0.74; steroid users vs non-users: aHR 0.58; 95% CI 0.39-0.87). Most (98%) participants had detectable antibody levels at 52 weeks post-vaccination. Antibody levels at 12 weeks and number of vaccine doses were positively associated with higher antibody levels at 52 weeks, while anti-tumor necrosis factor (TNF) alpha therapy was negatively associated. Conclusions COVID-19 vaccination generates an effective and durable protective response for the vast majority of adults with IBD, including vulnerable populations such as corticosteroid users and older individuals. Patients with IBD benefit from COVID-19 booster vaccination.