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Immunosupression and Covid Vaccine Response

Sharing this https://www.medpagetoday.com/infectiousdisease/covid19/91775
About this study https://jamanetwork.com/journals/jama/fullarticle/2777685 and an ongoing study vaccineresponse.org

You need to register (free) to see the video or read the interview transcript with researcher Dorry Segev, MD, PhD, associate vice chair of surgery at Johns Hopkins University School of Medicine and professor of epidemiology at Bloomberg School of Public Health. The interview is about a recent study which measured antibodies in transplant patients who received a Covid-19 vaccine. The study found that only 17% had measurable antibodies after dose 1 as opposed to "basically" 100% in people with normal immunocompetent people according to big randomized patients. Only 8% of transplant patients on azathioprine had antibodies after dose 1.

Yes this study was on transplant patients but there is also another study that deals with chronic conditions including Crohn's.

From the interview:
"Makary: What does this mean? You studied organ transplant recipients. What does this mean for say non-organ transplant recipients who are on immunosuppressive medications for other reasons?

Segev:
So we are studying that. So we have a parallel study, vaccineresponse.org, which covers people with chronic conditions. A lot of which either the condition itself or the medications they take are immunosuppressing. And so we're studying people with autoimmune disease, IBD, cirrhosis, ESRD, HIV, et cetera. We're just starting to get data from that. I'll give you kind of the, the gestalt is that if you are on immunosuppression agents, such as mycophenolate, azathioprine, you will probably have a blunted immune response, no matter what reason [there] is for taking those immunosuppression agents."

Dorry Segev, MD, PhD, says "I would love for the CDC to say much more firmly, if you are taking immunosuppression do not assume you have immunity because you have been vaccinated."

My take:I think this is important since the current CDC guidelines seem to assume immunity if you are 2 weeks post second COVID-19 vaccine but if you are on azathioprine, and possibly other immunosuppressants, that may not be true.

If you haven't had your COVID vaccine, vaccineresponse.org is currently enrolling people with chronic conditions like Crohn's. "The purpose of this research study is to determine COVID-19 antibody levels in patients with chronic conditions who receive the COVID-19 vaccine. The study does not provide the vaccine, and study team members will not be offering guidance as to whether one should or should not receive the SARS-CoV-2 vaccine. If participants will be receiving a vaccine and are interested in the study, we will collect a sample before vaccination, and collect samples at sequential time points post-vaccination to determine antibody levels." People enrolled in the study are told if they have detectable antibodies to Covid-19.
 

Lisa

Adminstrator
Staff member
Location
New York, USA
Thanks for this info! I've signed up to see if I'm eligible - I've had the vaccine already (2nd shot only 2 weeks ago), and tested a few months ago with negative antibodies...
 
I signed up for this study a few weeks ago since I'm on weekly humira and low dose of azathioprine (50mg/day) and got accepted. I'm just waiting to get my post vaccine bloodwork done. It will be interesting to see what the study and my personal antibodies levels are.

A part of me believes I have a decent level of antibodies since I did have a response (side effects) to the 2nd Pfizer dose but we'll see what the labs show.. will keep you guys posted.
 

Lynda Lynda

Member
I saw a lady walk into Sonora Labs the other day to request the antibody test, I believe it is available and the lady had to pay for it herself. Not sure if doctors orders are required for a person to get the antibody blood test at Sonora Labs. I live in the USA. I have not had the Covid vaccine yet. Take Care.
 
I saw a lady walk into Sonora Labs the other day to request the antibody test, I believe it is available and the lady had to pay for it herself. Not sure if doctors orders are required for a person to get the antibody blood test at Sonora Labs. I live in the USA. I have not had the Covid vaccine yet. Take Care.
The lab work is being done by Labcorp and is being paid for in my case as part of the study. I'm sure people can request it on their own but I'm not sure if the insurance companies are willing to pay for it.
 

my little penguin

Moderator
Staff member
I think it has to do with timing
When was meds taken /when was vaccine given
And what med or med combos the person is on

still trying to get Ds the vaccine -working on it
 

Lady Organic

Moderator
Staff member
''Transplant recipients receiving anti–metabolite maintenance immunosuppression therapy were less likely to develop an antibody response than those not receiving such immunosuppression therapy (37% vs 63%, respectively. Older transplant recipients were less likely to develop an antibody response. Those who received mRNA-1273 (MODERNA) were more likely to develop an antibody response than those receiving BNT162b2 (69% vs 31%, respectively.''

Im taking an anti-metabolite (purinethol) :(
I'd prefer to get the Moderna vaccine for better chances.
What is aweful is that in Canada the 2nd dose is being delayed by up to 4 months. I don't like being taken for a guinea pig.
I am really undecided on what to do. My turn is coming real soon. I wonder if I should wait for more research to come up regarding how to manage our case or just go and hope for the best.
 
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Lynda Lynda

Member
They have opened up the Covid vaccines for people in my age group in the USA, but I haven't even attempted to find out the process to get the vaccine. I live in the same household as an 88 year old lady and she has not even received her first vaccination !
 

my little penguin

Moderator
Staff member
We are just getting it for ds when he is cleared
Odds are most will need a booster shot anyways
So better to be protected for a while
Since it will be a bit before boosters are given out

as far as getting a shot in the US
Go to your states website for covid vaccine
There are websites
Rite aid
Cvs pharmacy
Walgreens
Costco
Walmart
All have websites to easily
Click
Enter your name age weakened immune system
Click
And you can schedule a shot

vaccine finder has list of places near you
And
Find a shot dot org
Has list of active available appointments that you can click to each Pharmacy and register
No insurance is required
 
I signed up for this study a few weeks ago since I'm on weekly humira and low dose of azathioprine (50mg/day) and got accepted. I'm just waiting to get my post vaccine bloodwork done. It will be interesting to see what the study and my personal antibodies levels are.

A part of me believes I have a decent level of antibodies since I did have a response (side effects) to the 2nd Pfizer dose but we'll see what the labs show.. will keep you guys posted.
Lucky - I’m also on weekly Humira with daily azathioprine and am curious if your GI recommended making any adjustments to the timing of your meds with your COVID vaccinations.

All my doc said was to get it as soon as I could when I talked with her last Fall. I know there is not much research out there on timing of dosage with the COVID shot, but what little I could find seemed to indicate timing of most biologics didn’t need to be changed and could even be taken on the same day as the vaccine, if needed.

I got my first dose almost two weeks ago (the day before I take my Humira) and think I may ask my GI if she thinks there would be any benefit to delaying my Humira by a few extra days after my second dose. So, of course I’m curious if your doc had any thoughts/advice about that and what you ended up doing!

I only experienced minor injection pain, headache, and fatigue for a couple days, so I’m anxious to see how my second dose will feel! A part of me is wanting to have a more noticeable response because I’m hoping that means my body is building a good amount of antibodies.

Thanks for your response! I enrolled in a similar study and am intrigued to know how my antibody test will turn out when the time comes. :)
 
Lucky - I’m also on weekly Humira with daily azathioprine and am curious if your GI recommended making any adjustments to the timing of your meds with your COVID vaccinations.

All my doc said was to get it as soon as I could when I talked with her last Fall. I know there is not much research out there on timing of dosage with the COVID shot, but what little I could find seemed to indicate timing of most biologics didn’t need to be changed and could even be taken on the same day as the vaccine, if needed.

I got my first dose almost two weeks ago (the day before I take my Humira) and think I may ask my GI if she thinks there would be any benefit to delaying my Humira by a few extra days after my second dose. So, of course I’m curious if your doc had any thoughts/advice about that and what you ended up doing!

I only experienced minor injection pain, headache, and fatigue for a couple days, so I’m anxious to see how my second dose will feel! A part of me is wanting to have a more noticeable response because I’m hoping that means my body is building a good amount of antibodies.

Thanks for your response! I enrolled in a similar study and am intrigued to know how my antibody test will turn out when the time comes. :)
Before I got my vaccine I had the same concerns as you regarding the timing so I called my GI asking for specifics. He instructed me to continue with all my medications as scheduled..no skipping doses even if the vaccine doses landed the same day.

With that said, my first dose happened the same day as my humira shot day (Friday). I had my 1st vaccine dose around lunch time and then came home and did my humira pen. The only symptom I had with the 1st dose was a sore arm at injection site for a few days. It wasn't too terrible...quite frankly the last tetanus shot I got 3 years ago hurt more!

For my 2nd dose I had that on a Thursday during lunch, day before my humira shot. The next day (Friday), I took my humira shot as usual. However, with the 2nd dose I had flu like symptoms the next day (Friday, same day as my humira). I did end up taking a Tylenol PM to help with the side effects and took it easy most of the day resting/sleeping. By Saturday, I had a bad migrane like headache...it was bearable, I took anotherTylenol. Sunday I was back to normal like nothing happened.

Despite experiencing side effects with the 2nd dose, I was kind of glad. I'm interpreting this as a good sign that the vaccine is working for me. I also want to note that my UC is still in remission through all this. I know many are afraid that the vaccine will cause a flare or blame the vaccine for flares.
 
That’s actually quite reassuring to hear, especially coming from someone else on weekly Humira shots! I was beginning to worry my minor side effects from the first shot was because I took my Humira the day after my first COVID shot. o_O Your Humira/COVID vaccine timing is very similar to mine as well, so it’s encouraging to hear you still had a noticeable immune response after the second dose despite the Humira injections being so close.

Now I’m looking forward to getting my second shot even more now! LOL. :p Thanks for sharing!
 

my little penguin

Moderator
Staff member
Patients being treated with infliximab had weakened immune responses to the first dose of the ChAdOx1 nCoV-19 (Oxford/AstraZeneca) and BNT162b2 (Pfizer/BioNTech) vaccines, compared with patients on vedolizumab (Entyvio), although a very significant number of patients from both groups seroconverted after their second dose, according to a new U.K. study of patients with inflammatory bowel disease(IBD).

"Antibody testing and adapted vaccine schedules should be considered to protect these at-risk patients," Nicholas A. Kennedy, PhD, MBBS, of the University of Exeter (England) and colleagues wrote in a preprint published March 29 on MedRxiv.

Infliximab is an anti–tumor necrosis factor (anti-TNF) monoclonal antibody that's approved to treat adult and pediatric Crohn's disease and ulcerative colitis, as well as rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, and plaque psoriasis, whereas vedolizumab, a gut selective anti-integrin alpha4beta7 monoclonal antibody that is not associated with impaired systemic immune responses, is approved to treat Crohn's disease and ulcerative colitis in adults.


A previous study from Kennedy and colleagues revealed that IBD patients on infliximab showed a weakened COVID-19 antibody response compared with patients on vedolizumab. To determine if treatment with anti-TNF drugs impacted the efficacy of the first shot of these two-dose COVID-19 vaccines, the researchers used data from the CLARITY IBD study to assess 865 infliximab- and 428 vedolizumab-treated participants without evidence of prior SARS-CoV-2 infection who had received uninterrupted biologic therapy since being recruited between Sept. 22 and Dec. 23, 2020.

In the 3-10 weeks after initial vaccination, geometric mean concentrations for SARS-CoV-2 anti-spike protein receptor-binding protein antibodies were lower in patients on infliximab, compared with patients on vedolizumab for both the Pfizer (6.0 U/mL [5.9] versus 28.8 U/mL [5.4], P < .0001) and AstraZeneca (4.7 U/mL [4.9] versus 13.8 U/mL [5.9]; P < .0001) vaccines. The researchers' multivariable models reinforced those findings, with antibody concentrations lower in infliximab-treated patients for both the Pfizer (fold change, 0.29; 95% confidence interval, 0.21-0.40; P < .0001) and AstraZeneca (FC, 0.39; 95% CI, 0.30-0.51; P < .0001) vaccines.

After second doses of the two-dose Pfizer vaccine, 85% of patients on infliximab and 86% of patients on vedolizumab seroconverted (P = .68); similarly high seroconversion rates were seen in patients who had been infected with SARS-CoV-2 prior to receiving either vaccine. Several patient characteristics were associated with lower antibody concentrations regardless of vaccine type: being 60 years or older, use of immunomodulators, having Crohn's disease, and being a smoker. Alternatively, non-White ethnicity was associated with higher antibody concentrations.


Evidence Has 'Unclear Clinical Significance'

"These data, which require peer review, do not change my opinion on the safety and efficacy of COVID-19 vaccines in patients taking TNF inhibitors such as infliximab as monotherapy for the treatment of psoriatic disease," Joel M. Gelfand MD, director of the psoriasis and phototherapy treatment center at the University of Pennsylvania, Philadelphia, said in an interview.

"First, two peer-reviewed studies found good antibody response in patients on TNF inhibitors receiving COVID-19 vaccines (doi: 10.1136/annrheumdis-2021-220289; 10.1136/annrheumdis-2021-220272). Second, antibody responses were robust in the small cohort that received the second dose of a COVID-19 vaccine. We already know that, for the two messenger RNA-based vaccines available under emergency use authorization in the U.S., a second dose is required for optimal efficacy. Thus, evidence of a reduced antibody response after just one dose is of unclear clinical significance. Third, antibody responses are only a surrogate marker, and a low antibody response doesn't necessarily mean the patient will not be protected by the vaccine."

Focus on the Second Dose of a Two-Dose Regimen
"Tell me about the response in people who got both doses of a vaccine that you're supposed to get both doses of," Jeffrey Curtis, MD, professor of medicine in the division of clinical immunology and rheumatology at the University of Alabama at Birmingham, said in an interview. "The number of patients in that subset was small [n = 27] but in my opinion that's the most clinically relevant analysis and the one that patients and clinicians want answered."

He also emphasized the uncertainty around what 'protection' means in these early days of studying COVID-19 vaccine responses. "You can define seroprotection or seroconversion as some absolute level of an antibody response, but if you want to say 'Mrs. Smith, your antibody level was X,' on whatever arbitrary scale with whoever's arbitrary lab test, nobody actually knows that Mrs. Smith is now protected from SARS-CoV-2, or how protected," he said.


"What is not terribly controversial is: If you can't detect antibodies, the vaccine didn't 'take,' if you will. But if I tell you that the mean antibody level was X with one drug and then 2X with another drug, does that mean that you're twice as protected? We don't know that. I'm fearful that people are looking at these studies and thinking that more is better. It might be, but we don't know that to be true."


Debating the Cause of Weakened Immune Responses
"The biological plausibility of being on an anti-TNF affecting your immune reaction to a messenger RNA or even a replication-deficient viral vector vaccine doesn't make sense," David T. Rubin, MD, professor of medicine at the University of Chicago and chair of the National Scientific Advisory Committee of the Crohn's and Colitis Foundation, said in an interview.


"I'm sure immunologists may differ with me on this, but given what we have come to appreciate about these vaccine mechanisms, this finding doesn't make intuitive sense. So we need to make sure that, when this happens, we look to the next studies and try to understand, was there any other confounder that may have resulted in these findings that was not adequately adjusted for or addressed in some other way?


"When you have a study of this size, you argue, 'Because it's so large, any effect that was seen must be real,' " he added. "Alternatively, to have a study of this size, by its very nature you are limited in being able to control for certain other factors or differences between the groups."


That said, he commended the authors for their study and acknowledged the potential questions it raises about the single-shot Johnson & Johnson vaccine. "If you only get one and you're on infliximab, this study implies that maybe that's not enough," he said. "Despite the fact that Johnson & Johnson was approved as a single dose, it may be necessary to think about it as the first of two, or maybe it's not the preferred vaccine in this group of patients."

from

 

Lady Organic

Moderator
Staff member
from

Thanks! thats good to know! I am going to wait a bit so that this information gets to public health autorities so that I can be offered a better schedule of vaccination (not a 4 month wait for the 2nd dose). I dont mind waiting.
I consider myself at very low risk of contracting covid. I've remained very solitary since the begining of the pandemic and for the few times I have to go into indoor places, I always wear 2 masks.
I also want to wait to see if the current vaccines will protect well against the new variants. I have heard immunologists say the current vaccines do not protect as well against the Brazilian variant. last thing I want is to have to be vaccinated and revaccinated over and over again.
So I will wait and continue my isolation and see how this all evolves.
 

my little penguin

Moderator
Staff member
@Lady Organic
Regardless of vaccine used
The odds are very high that everyone will need a booster vaccine shot
Viruses mutate which is why there is a South African variant ,uk variant etc...
Similar to flu vaccines-the flu virus mutates a little and you get a new shot every year to protect against the most prevalent version
The good thing so far is while no vaccine protects 100% against all the variants
They all protect 100% against severe disease (ICU ) and death
So while you may still get sick for the majority it will be mild after receiving the vaccine

@Karinbe
Please have your docs refer you to an immunologist who specializes in auto inflammatory conditions
Auto inflammatory conditions can mimic crohns and they tend to trigger huge hospital worth flares in some (depending on disease ) from simple things like a vaccine .
Ds has crohns and an auto inflammatory conditions
But so far vaccines in general have not triggered his auto inflammatory disease ,but he does take a separate biologic to control the auto inflammatory disease
 
@Lady Organic
Regardless of vaccine used
The odds are very high that everyone will need a booster vaccine shot
Viruses mutate which is why there is a South African variant ,uk variant etc...
Similar to flu vaccines-the flu virus mutates a little and you get a new shot every year to protect against the most prevalent version
The good thing so far is while no vaccine protects 100% against all the variants
They all protect 100% against severe disease (ICU ) and death
So while you may still get sick for the majority it will be mild after receiving the vaccine

@Karinbe
Please have your docs refer you to an immunologist who specializes in auto inflammatory conditions
Auto inflammatory conditions can mimic crohns and they tend to trigger huge hospital worth flares in some (depending on disease ) from simple things like a vaccine .
Ds has crohns and an auto inflammatory conditions
But so far vaccines in general have not triggered his auto inflammatory disease ,but he does take a separate biologic to control the auto inflammatory disease
Never heard of that. Even biggest hospital in Belgium does not have immunologist specialized in auto immune conditions. They refer me always to GI or Reuma departments.
 

my little penguin

Moderator
Staff member
Some rheumatologist also handle auto inflammatory
Definitely worth asking
Ds was sick with things we thought were due to crohns
Low grade fever
Chills
Fatigue /exhaustion
Flushing
Rashes / mouth ulcers
Muscle aches
Joint pain
Headaches
Eye pain
The dermatologist did a biopsy of his rash and determined he had Sweets -neutrophilic dermatosis
Once it was under control -made his crohns easier to control
 
I wouldn’t touch that covid gene therapy with a 10 foot pole. I am astonished at how many people aren’t blinking an eye on this forum.
It's not gene therapy - it doesn't change your DNA in any way. The m in mRNA stands for messenger. Once it sends a message to cells' protein factories to create a batch of spike proteins, the message disappears, and the immune system handles the rest once it realizes that a thing that isn't usually in your body is there now.
 
Location
San Diego
I'm on Stelara, and I am fully vaccinated with the Moderna vaccine as of mid-February. So far no side effects beyond a temporary sore arm at the injection site.

It was my judgment that the known risks from the disease were much greater than the theoretical risks from the vaccine.

Plus, COVID vaccination for IBD patients is strongly recommended by International Organization for the Study of Inflammatory Bowel Disease (IOIBD) - an organization of the top IBD specialists and researchers:
https://ioibd.org/wp-content/uploads/2021/01/gutjnl-2020-324000.full_.pdf
 

Tesscorm

Moderator
Staff member
CCFC has a downloadable letter available on its site which can be used to request an earlier second dose if you are on immunotherapy. My son's GI signed the letter requesting that he receive his second dose 21 days after his first shot. His GI had to specify on the letter that he was requesting the early dose.

I don't know if the vaccine clinic can override the request?? My son is going for his first shot tomorrow and will take the letter with him. I'll let you know if he has any pushback on scheduling his second dose.

(Also, his GI's office recommended that the vaccine be given one week apart from his infusion.)
 

Lisa

Adminstrator
Staff member
Location
New York, USA
So, I received my antibody test results last night and I tested positive for antibodies 1 month after receiving my 2nd dose of the Pfizer vaccine. It didn't give me an antibody level, just 'positive'. I'll get blood drawn again in 2 months to see how my antibodies are then.....

Also, I have NOT had Covid, actually had my first test Tuesday morning (pre-op required testing) and had my negative results within 24 hours.
 
So, I received my antibody test results last night and I tested positive for antibodies 1 month after receiving my 2nd dose of the Pfizer vaccine. It didn't give me an antibody level, just 'positive'. I'll get blood drawn again in 2 months to see how my antibodies are then.....

Also, I have NOT had Covid, actually had my first test Tuesday morning (pre-op required testing) and had my negative results within 24 hours.
That's really promising! I am still waiting to hear back from the study to schedule my post vaccine lab work.
 

Lady Organic

Moderator
Staff member
CCFC has a downloadable letter available on its site which can be used to request an earlier second dose if you are on immunotherapy. My son's GI signed the letter requesting that he receive his second dose 21 days after his first shot. His GI had to specify on the letter that he was requesting the early dose.

I don't know if the vaccine clinic can override the request?? My son is going for his first shot tomorrow and will take the letter with him. I'll let you know if he has any pushback on scheduling his second dose.

(Also, his GI's office recommended that the vaccine be given one week apart from his infusion.)
How did it go with the letter, did they accept the 2nd dose in 2 weeks?
Did you bring this one only or the advocacy letter along with it?
EDIT* I just spoke with my pharmacist and she told me that they stick to the authorities guidelines and that as of today, immunosupprssion is not yet considered an exception for rapid 2nd dose, so she cant schedule me for a 2nd dose in two weeks, even if my doctor writes a advocacy letter. She proposed to me a vaccine for tomorrow but with 2nd dose in August. I declined the offer. I would like proper schedule and also, the assurance to get the same vaccine for 2nd dose. I fear a lot of people in Canada wont even get the same brand of vaccine 4 months later... This doesnt agree with me.
 
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Lynda Lynda

Member
I am getting my first Covid vaccine today. It is the Moderna. After my first dose then I have been instructed to go online to schedule my second dose. The second dose would be given at the same location.

I live in Arizona, USA. I am 60 years old and have been using Humira Injection Pens for 3 years to treat my Crohn's Disease. I was recently diagnosed with a Crohn's flare and just started taking Prednisone [ for the next 20 days.] I wll be having a CT Enterography soon to collect more detailed medical information so that my current diagnosis of a flare can be confirmed. It appears that my Crohn's Disease is not being managed as well as it should be. I am eating a full liquid diet / soft food diet right now.

This is surely not the best timing for me to get the vaccine, because my Crohn's symptoms are not under control, but I need to weigh the pros and the cons of the vaccine. I was also diagnosed with latent TB this year and am taking Rifampin to treat that ! This year I am not as healthy as I wish to be. I don't feel like the Humira is working for me any longer.

My State has recently opened up the Covid vaccine for the 16 and 17 year old age group, in my opinion this is being done only to make Arizona look like we have exceeded every other State in the number of people vaccinated. But who knows.

I have signed up online for that John Hopkins Covid 19 Vaccine Antibody
Research Study.

Take Care.
 
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