Antibody decay, T cell immunity and breakthrough infections following two SARS-CoV-2 vaccine doses in inflammatory bowel disease patients treated with infliximab and vedolizumab

Anti tumour necrosis factor (anti-TNF) drugs increase the risk of serious respiratory infection and impair protective immunity following pneumococcal and influenza vaccination. Here we report SARS-CoV-2 vaccine-induced immune responses and breakthrough infections in patients with inflammatory bowel disease, who are treated either with the anti-TNF antibody, infliximab, or with vedolizumab targeting a gut-specific anti-integrin that does not impair systemic immunity. Geometric mean [SD] anti-S RBD antibody concentrations are lower and half-lives shorter in patients treated with infliximab than vedolizumab, following two doses of BNT162b2 (566.7 U/mL [6.2] vs 4555.3 U/mL [5.4], p <0.0001; 26.8 days [95% CI 26.2 – 27.5] vs 47.6 days [45.5 – 49.8], p <0.0001); similar results are also observed with ChAdOx1 nCoV-19 vaccination (184.7 U/mL [5.0] vs 784.0 U/mL [3.5], p <0.0001; 35.9 days [34.9 – 36.8] vs 58.0 days [55.0 – 61.3], p value < 0.0001). One fifth of patients fail to mount a T cell response in both treatment groups. Breakthrough SARS-CoV-2 infections are more frequent (5.8% (201/3441) vs 3.9% (66/1682), p = 0.0039) in patients treated with infliximab than vedolizumab, and the risk of breakthrough SARS-CoV-2 infection is predicted by peak anti-S RBD antibody concentration after two vaccine doses. Irrespective of the treatments, higher, more sustained antibody levels are observed in patients with a history of SARS-CoV-2 infection prior to vaccination. Our results thus suggest that adapted vaccination schedules may be required to induce immunity in at-risk, anti-TNF-treated patients.

Author list


Simeng Lin, 

Nicholas A. Kennedy, 

Aamir Saifuddin, 

Diana Muñoz Sandoval, 

Catherine J. Reynolds, 

Rocio Castro Seoane, 

Sherine H. Kottoor, 

Franziska P. Pieper, 

Kai-Min Lin, 

David K. Butler, 

Neil Chanchlani, 

Rachel Nice, 

Desmond Chee, 

Claire Bewshea, 

Malik Janjua, 

Timothy J. McDonald, 

Shaji Sebastian, 

James L. Alexander, 

Laura Constable, 

James C. Lee, 

Charles D. Murray, 

Ailsa L. Hart, 

Peter M. Irving, 

Gareth-Rhys Jones, 

Klaartje B. Kok, 

Christopher A. Lamb, 

Charlie W. Lees, 

Daniel M. Altmann, 

Rosemary J. Boyton, 

James R. Goodhand, 

Nick Powell, 

Tariq Ahmad & 


Novel Coronavirus SARS-CoV-2


Nature - Communications