Q: My daughter has Inflammatory Bowel Disease (IBD) and is on Remicade. Is there any information on the immune response to COVID-19 vaccines in people on Remicade?
A: People on some immunosuppressive medicines are showing weaker responses to COVID-19 vaccines.
Remicade is one of many immunosuppressive medicines. People who are on immunosuppressive treatment may have a lower response to COVID-19 vaccines compared with people who have a normal immune system. The level of vaccine response depends on many factors including:
(1) the type of immunosuppressive medicines that a person is taking
(2) whether they have an inherited immune defect
(3) if they have any other underlying health problems
It is important to note that COVID-19 vaccines are SAFE but may not induce a good immune response in some immunosuppressed people.
❓ Why does a person’s immune system need to be suppressed? Medicines to suppress a person’s immune system are prescribed for a variety of reasons. People who have an autoimmune disease such as rheumatoid arthritis or Crohn’s disease are prescribed immunosuppressants to stop their own immune system from attacking their tissues. People who have had an organ transplant or a bone marrow transplant will be on immunosuppression to stop their immune system from attacking the newly engrafted organ or bone marrow cells. People who have certain types of blood cancers may be on treatment to kill cancerous cells; some of these treatments will also kill normal immune cells.
❓ What are the types of immunosuppressive medicines? Some medicines such as steroids are broadly immunosuppressive. Others might target one type of cell, such as Rituxan that is used to destroy B cells in certain kinds of leukemia and in some autoimmune diseases. Other drugs such as Remicade, Enbrel and Humira are used to block a specific inflammation-inducing molecule, TNF-alpha. People who have undergone an organ or bone-marrow transplant will be on treatment to suppress their T cells so that their immune system doesn’t reject their transplant. While all of these medications are very important for treating a specific disease or preventing transplant rejection, they also decrease the immune system’s ability to make a good response to infection or vaccination. How far their immune response is dampened may depend on the type of immunosuppression.
❓ Does immunosuppression affect the response to COVID-19 vaccines? Although we do not yet have robust data on the effect of specific types of immunosuppressive medicines on the COVID-19 vaccine response, some data is beginning to emerge. In a study of 658 people with organ transplants, 15% made an antibody response after both the first and second doses of the COVID-19 mRNA vaccines, 39% had a response after the second dose but not the first dose, and 46% had no antibody response after two doses. These data indicate that some organ transplant patients may continue to be at risk of SARS-CoV-2 infection even after vaccination. Another study of patients on Remicade, the drug used to treat Crohn’s disease, rheumatoid arthritis and other autoimmune diseases showed that these people had a lower antibody response to the first COVID-19 dose compared with healthy people. However, antibody levels went up significantly after the second vaccine dose in these patients. Also, in a few patients who had COVID-19 before vaccination, the antibody response after the first vaccine dose was quite robust. These data indicate that receiving BOTH doses of the COVID-19 mRNA vaccines is very important for people who are taking medicines such as Remicade.
💥 Be sure not to miss the second dose!
Doctors are working on the timing of COVID-19 vaccine administration in relation to immunosuppressive treatment using the knowledge gained from vaccines such as the flu vaccine or pneumococcal vaccine that are given to immunocompromised people. Whether to temporarily halt immunosuppressive medicines in order to give a person the COVID-19 vaccine is a decision that is VERY specific to that person and their doctor.
💥 Importantly, COVID-19 vaccines have a good safety profile but may not induce as good of an immune response in immunosuppressed people. However, any immune response to the vaccine, however low, is still important as it may reduce the severity of COVID-19 in immunosuppressed people. And some immunity is better than none. At the same time, keep in mind that because the immune response to vaccines is lower in immunocompromised people, maintaining safety measures such as masking is very important to protect this vulnerable population. Additional information on COVID-19 vaccines and immunosuppression is here.
✋ A cautionary note regarding antibody testing: If you have received a COVID-19 vaccine, you might have asked for an antibody test to check if you have responded to vaccination. In general, antibody testing is not necessary if you have a healthy immune system. If you are immunocompromised and have a negative COVID-19 antibody test, be sure to ask whether you were tested for antibodies to the SARS-CoV-2 spike protein – the protein used in COVID-19 vaccines. More information on the difference between antibodies due to infection and vaccination is here. If you have questions about an antibody test result, please talk with your doctor.
Stay safe.
Love,
Those Nerdy Girls
📖 Further reading:
From the American College of Rheumatology
Antibody response in organ transplant:
