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Lower Sustained Diphtheria and Pertussis Antibody Concentrations in Inflammatory Bowel Disease Patients

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Abstract

Background

Patients with inflammatory bowel disease (IBD) are often immunosuppressed, and those patients receiving anti-tumor necrosis factor α (TNF) therapy can have lower antibody responses to vaccines. Pertussis cases are at their highest levels in the post-vaccine era. There is little data regarding responses to the Tdap (tetanus, diphtheria, and acellular pertussis) vaccine in IBD patients.

Aims

The aim of this study was to compare sustained vaccine-induced Tdap antibody concentrations in a cohort of IBD patients stratified by medication regimens with healthy controls (HC) who had received an adult Tdap booster.

Methods

We performed a cross-sectional study evaluating antibody responses to Tdap vaccine among IBD patients compared to HC. Our study consisted of three patient groups: adults with IBD stratified by maintenance medication regimen: (1) thiopurine monotherapy; (2) anti-TNF monotherapy; and (3) combination therapy (anti-TNF and immunomodulator (thiopurine or methotrexate)).

Results

Ninety IBD patients and 20 HC participated. Pertussis pertactin antibody concentrations were significantly lower in IBD patients (p = 0.021) compared to HC, and those on anti-TNF agents (monotherapy or combination) had lower antibody concentrations compared to those on thiopurine monotherapy (p = 0.028). Diphtheria antibody concentrations were also lower in IBD patients (p < 0.001), and those on anti-TNF agents (monotherapy or combination) had lower antibody concentrations compared to the thiopurine monotherapy group (p < 0.001).

Conclusion

IBD patients on anti-TNF agents had lower antibody concentrations to diphtheria and pertussis. These findings suggest a need for different Tdap booster schedules for IBD patients on anti-TNF therapy.

Clinical Trials Registry NCT02434133.

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Acknowledgments

The project described was supported by the Clinical and Translational Science Award (CTSA) program, through the NIH National Center for Advancing Translational Sciences (NCATS), Grant UL1TR000427. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

Funding

This work was supported by the Sal Family Foundation, University of Wisconsin Division of Gastroenterology and Hepatology and the University of Wisconsin School of Pharmacy.

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Authors and Affiliations

  1. Department of Medicine, Division of Gastroenterology and Hepatology, University of Wisconsin School of Medicine and Public Health, 1685 Highland Avenue, Madison, WI, 53705-2281, USA

    Freddy Caldera, Sumona Saha, Arnold Wald & Mark Reichelderfer

  2. School of Medicine and Public Health, University of Wisconsin, 750 Highland Ave., Madison, WI, 53705, USA

    Bryant Megna & Dana Ley

  3. School of Pharmacy, University of Wisconsin, 777 Highland Ave., Madison, WI, 53705, USA

    Christine A. Garmoe, Sue McCrone & Mary S. Hayney

Authors
  1. Freddy Caldera
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  2. Sumona Saha
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  3. Arnold Wald
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  4. Christine A. Garmoe
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  5. Sue McCrone
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  6. Bryant Megna
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  7. Dana Ley
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  8. Mark Reichelderfer
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Corresponding author

Correspondence to Freddy Caldera.

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Conflict of interest

Drs. Caldera, Wald and Reichelderfer and Ms. McCrone, Ms. Garmoe, Mr. Megna, and Ms. Ley declare that they have no competing interests/financial disclosures. Dr. Hayney serves on the speakers’ bureau for Sanofi Pasteur Vaccines. Dr. Saha is a consultant with UCB Biosciences.

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Caldera, F., Saha, S., Wald, A. et al. Lower Sustained Diphtheria and Pertussis Antibody Concentrations in Inflammatory Bowel Disease Patients. Dig Dis Sci 63, 1532–1540 (2018). https://doi.org/10.1007/s10620-018-5043-2

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  • DOI: https://doi.org/10.1007/s10620-018-5043-2

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