Article
作者: Dütschler, Joel ; König, Marius ; Truniger, Samuel ; Brand, Stephan ; Krupka, Niklas ; Leinenkugel, Georg ; Niess, Jan Hendrik ; Oikonomou, Vasileios ; Wyss, Jacqueline ; Friedrich, Matthias ; Woelfel, Simon ; Graf, Nicole ; Schneiderhan‐Marra, Nicole ; Krieger, Claudia ; Bürgi, Justus J. ; Misselwitz, Benjamin ; Albrich, Werner C. ; Koller, Seraina ; Korte, Wolfgang ; Frei, Nicola ; Dulovic, Alex ; Junker, Daniel ; Metzger‐Peter, Katline
ABSTRACTBackgroundVariant‐adapted COVID‐19 vaccines are recommended for patients with inflammatory bowel disease (IBD). However, many patients rely on pre‐existing immunity by original vaccines or prior infections.AimTo assess whether such immunity sufficiently combats the highly immune‐evasive SARS‐CoV‐2 JN.1 variant.MethodsUtilising two longitudinal cohorts, we evaluated immunity against JN.1 induced by original vaccines (IBD: n = 98; healthy: n = 48), omicron breakthrough infection (IBD: n = 55; healthy: n = 57) or XBB.1.5‐adapted vaccines (IBD: n = 18). Neutralisation and anti‐receptor‐binding domain (RBD) IgG levels against wild‐type SARS‐CoV‐2 and JN.1 were assessed using multiplex immunoassays. Study outcomes were wild‐type and JN.1 neutralisation following three doses of original mRNA vaccines, stratified by immunosuppressive therapy (primary outcome), and JN.1 neutralisation following third‐dose breakthrough infection or a fourth dose of XBB.1.5‐adapted mRNA vaccines (secondary outcomes).ResultsFollowing original vaccines, JN.1 neutralisation was lower than wild‐type neutralisation in all study groups (healthy, anti‐TNF and non‐anti‐TNF; each p < 0.001); most individuals lacked JN.1 neutralisation (healthy: 97.9%; anti‐TNF: 98.3% and non‐anti‐TNF: 92.3%). Confounder‐adjusted multivariable modelling strongly associated anti‐TNF therapy with low levels of anti‐JN.1‐RBD IgG (fold‐change 0.48 [95% CI 0.39–0.59]). JN.1 neutralisation was similar in patients with or without breakthrough infection (anti‐TNF, non‐anti‐TNF; each p > 0.05); neutralisation failure was 100% despite breakthrough infection. XBB.1.5‐adapted vaccines enhanced JN.1 neutralisation (p < 0.001) and reduced neutralisation failure rates in patients with IBD (94.4% pre‐vaccination vs. 44.4% post‐vaccination; p = 0.003).ConclusionsOnly variant‐adapted vaccines protect against emerging SARS‐CoV‐2 variants. Patients with IBD and healthy individuals without recent vaccination may lack protection against the JN.1 subvariant KP.3 which causes current COVID‐19 surges.