SARS-CoV-2 vaccination in patients with inflammatory bowel disease: systemic review and meta-analysis

BACKGROUND: In the COVID-19 pandemic, SARS-CoV-2 vaccination has been effective in preventing COVID-19 infections and related mortality. The SARS-CoV-2 vaccination was also recommended by the international society for patients with inflammatory bowel disease (IBD). However, IBD patients were not recruited in prospective randomized clinical vaccine studies. To evaluate the efficacy and safety of SARS-CoV-2 vaccination in IBD patients, we conducted this systemic review and meta-analysis. METHODS: We systematically searched PubMed, Medline, and the Cochrane Library for studies published between Jan 1, 2019, and Sep 9, 2021. Studies written in English reported the efficacy, seroconversion (anti-SARS-CoV-2 anti-spike(S) antibody titer beyond the threshold) rate and adverse events after SARS-CoV-2 vaccination in IBD patients. We extracted the author, date, study design, country, types of SARS-CoV-2 vaccination, number of IBD patients receiving SARS-CoV-2 vaccinations, and study outcomes. Published data from the enrolled studies were pooled to determine effect estimates. The study protocol was registered in PROSPERO (CRD42021264993). RESULTS: We analyzed findings from 27454 IBD patients that received SARS-CoV-2 vaccinations in 11 studies that met the inclusion criteria. The post SARS-CoV-2 vaccination COVID-19 infection rate was comparable between the IBD patients and non-IBD patients (odds ratio (OR), 1.28, 95% confidence interval (CI) 0.96-1.71) and higher in nonvaccinated IBD patients compared with vaccinated IBD patients (OR 8.63, 95% CI 5.44-13.37). The adverse event rate, severe adverse events and mortality after SARS-CoV-2 vaccination were 69%, 3% and 0%, respectively. CONCLUSION: The SARS-CoV-2 vaccine is effective and tolerated in preventing COVID-19 infections in IBD patients. Over 98% of patients had seroconversion after receiving all doses of the SARS-CoV-2 vaccination, and the influence of biologics on vaccination was limited. The SARS-CoV-2 vaccination is recommended for IBD patients.