Did We Overreact? Insights on COVID-19 Disease and Vaccination in a Large Cohort of Immune-Mediated Inflammatory Disease Patients during Sequential Phases of the Pandemic (The BELCOMID Study)

Jeroen Geldof; Marie Truyens; João Sabino; Marc Ferrante; Jo Lambert; Hilde Lapeere; Tom Hillary; An Van Laethem; Kurt de Vlam; Patrick Verschueren; Triana Lobaton; Elizaveta Padalko; Séverine Vermeire

doi:10.3390/vaccines12101157

Did We Overreact? Insights on COVID-19 Disease and Vaccination in a Large Cohort of Immune-Mediated Inflammatory Disease Patients during Sequential Phases of the Pandemic (The BELCOMID Study)

Vaccines (Basel). 2024 Oct 11;12(10):1157. doi: 10.3390/vaccines12101157.

Authors

Jeroen Geldof^{1

2}, Marie Truyens^{1

2}, João Sabino^{3

4}, Marc Ferrante^{3

4}, Jo Lambert⁵, Hilde Lapeere⁵, Tom Hillary⁶, An Van Laethem⁶, Kurt de Vlam⁷, Patrick Verschueren⁷, Triana Lobaton^{1

2}, Elizaveta Padalko⁸, Séverine Vermeire^{3

4}

Affiliations

¹ Department of Gastroenterology and Hepatology, Ghent University Hospital, 9000 Ghent, Belgium.
² Department of Internal Medicine and Pediatrics, Ghent University, 9000 Ghent, Belgium.
³ Department of Gastroenterology and Hepatology, University Hospitals Leuven, 3000 Leuven, Belgium.
⁴ Translational Research in Gastrointestinal Disorders (TARGID), Department of Chronic Diseases and Metabolism (CHROMETA), KU Leuven, 3000 Leuven, Belgium.
⁵ Department of Dermatology, Ghent University Hospital, 9000 Ghent, Belgium.
⁶ Department of Dermatology, University Hospitals Leuven, 3000 Leuven, Belgium.
⁷ Department of Rheumatology, University Hospitals Leuven, 3000 Leuven, Belgium.
⁸ Department of Laboratory Medicine, Ghent University Hospital, 9000 Ghent, Belgium.

Abstract

Introduction: As the COVID-19 pandemic becomes an endemic state, still many questions remain regarding the risks and impact of SARS-CoV-2 infection and vaccination in patients with immune-mediated inflammatory diseases (IMIDs) who were excluded from the phase 3 COVID-19 vaccination trials.

Methods: The BELCOMID study collected patient data and serological samples from a large, multicentric IMID patient cohort that was prospectively followed during sequential stages of the pandemic. Patients were stratified according to vaccination status into five groups across three sampling periods. Interactions between SARS-CoV-2 infection, COVID-19 vaccination status, IMID-treatment modalities and IMID course were explored.

Results: In total, 2165 patients with IBD, a dermatological or rheumatological IMID participated. SARS-CoV-2 infection rates increased over the course of the pandemic and were highest in IMID patients that had refused every vaccine. After baseline COVID-19 vaccination, serologic spike (S)-antibody responses were attenuated by particular types of immune-modulating treatment: anti-TNF, rituximab, JAKi, systemic steroids, combined biologic/immunomodulator treatment. Nonetheless, S-antibody concentration increased progressively in patients who received a booster vaccination, reaching 100% seroconversion rate in patients who had received two booster vaccines. Previous SARS-CoV-2 infection was found as a predictor of higher S-antibody response. Patients who had refused every vaccine showed the lowest rates of S-seroconversion (53.8%). Multiple logistic regression did not identify previous SARS-CoV-2 infection as a risk factor for IMID flare-up. Furthermore, no increased risk of IMID flare-up was found with booster vaccination.

Conclusions: Altogether, the BELCOMID study provides evidence for the efficacy and safety of COVID-19 vaccination and confirms the importance of repeated booster vaccination in IMID patients.

Keywords: COVID-19; IMID; booster; real world; vaccination.

Grants and funding

BELCOMID received research grants from: Almirall, Roche, Janssen, Pfizer, Eli Lilly, Amgen, Biogen, Mylan, LEO Pharma. These grants were used to finance sample collection, study coordinators and support of the Ghent University Biostatistics Unit. The afore mentioned companies had no role in the study design, conduct or in the reporting of results.