Editorial: Updated COVID-19 Boosters—Tailoring Protection for Patients With IBD

Abstract

Patients with inflammatory bowel disease (IBD) treated with immunosuppressive agents are at increased risk of vaccine-preventable diseases [1]. During the COVID-19 pandemic, guidelines advised the prioritisation of immunosuppressed patients with IBD for extended primary and booster vaccination courses against SARS-CoV-2. The emergence of omicron variants and sub-variants, coupled with waning immunity, indicates that waves of SARS-CoV-2 infection pose an ongoing public health challenge, particularly for vulnerable patient groups [2]. Certain immunosuppressive therapies used in IBD and other immune-mediated inflammatory disorders, including anti-tumour necrosis factor (TNF) agents and Janus kinase (JAK) inhibitors, are associated with a blunted humoral immune response and an increased risk of breakthrough infection [3, 4].

Woelfel et al. evaluated patients from the STAR SIGN study who had received at least three doses of original mRNA vaccines to determine protection against the current JN.1 variant and evaluated a small subgroup who had received a fourth booster XBBB1.5 recommended during 2023–2024 [5]. They found that neutralisation failure against JN.1 was ubiquitous despite prior vaccination and breakthrough infection but was somewhat mitigated in the small group that received XBB.1.5-adapted booster. Multi-variable modelling implicates anti-TNF treatment as being associated with a greater than 50% reduction in anti-JN.1 neutralising antibodies. As the authors noted, these findings fall short of implying that immunosuppressed patients with IBD who do not receive variant-adapted boosters are at a greater risk of adverse outcomes from infection with JN.1. Nonetheless, this re-emphasises the importance of regular, variant-adapted booster vaccination against SARS-CoV-2 in immunosuppressed patients with IBD, particularly those receiving anti-TNF therapy.

Variant-adapted booster vaccines have been developed to combat the evolving SARS-CoV-2 variant landscape [6]. However, the determination of the groups that should receive such vaccines varies by jurisdiction. In June 2024, the US Centers for Disease Control and Prevention recommended that all individuals aged 6 months and older receive an updated vaccine targeting the JN.1 variant or KP.2 strain [6]. This recommendation was based on evidence that providing an updated 2023–2024 COVID-19 booster offered effectiveness against various outcomes, including symptomatic infection, hospitalisation and critical illness [6]. Moreover, this updated booster provided protection against COVID-19-related thromboembolic events [7]. Conversely, the United Kingdom Committee on Vaccination and Immunisation now advises a targeted approach that includes clinical risk groups such as immunosuppressed individuals with IBD [8] Amid this situation, there is growing vaccine hesitancy and complacency about the threat posed by COVID-19 [9].

Patients with IBD without an updated booster are at risk for SARS-CoV-2 infections that may result in SARS-CoV-2 “long Covid,” hospitalisation and thromboembolic events [6] and Herpes zoster in patients with IBD [10]. To potentially prevent these COVID-19 complications, gastroenterologists should advocate with their country's public health agencies to ensure that updated boosters are recommended and available for patients with IBD. Furthermore, they should educate their patients about the importance of vaccination and strongly recommend that they receive an updated booster.