Reduced antiviral seropositivity among patients with inflammatory bowel disease treated with immunosuppressive agents

Abstract

Background

Although live-attenuated vaccines are contraindicated under immunosuppression, the immune status of patients with inflammatory bowel disease (IBD) has not been fully assessed prior to immunosuppressive therapy.

Aims

To investigate antiviral serostatus against viruses requiring live vaccines for prevention in IBD patients undergoing immunosuppressive therapy.

Methods

This multicenter study included IBD patients who were aged <40 years and were treated with thiopurine monotherapy, molecular-targeted monotherapy, or combination therapy. Gender- and age-matched healthy subjects (HS) living in the same areas were included as control group. Antibody titers against measles, rubella, mumps, and varicella were measured by enzyme-linked immunosorbent assays.

Results

A total of 437 IBD patients (163 ulcerative colitis [UC] and 274 Crohn’s disease [CD]) and 225 HS were included in the final analysis. Compared with HS, IBD patients had lower seropositivity rates for measles (IBD vs. HS = 83.91% vs. 85.33%), rubella (77.55% vs. 84.89%), mumps (37.50% vs. 37.78%), and varicella (91.26% vs. 96.44%). Gender- and age-adjusted seropositivity rates were lower in UC patients than in both CD patients and HS for measles (UC, CD, and HS = 81.60%, 85.29%, and 85.33%), rubella (76.40%, 78.23%, and 84.89%), mumps (27.16%, 43.70%, and 37.78%), and varicella (90.80%, 91.54%, and 96.44%); the difference was significant for all viruses except measles. Divided by the degree of immunosuppression, there were no significant differences in seropositivity rates among IBD patients.

Conclusions

IBD patients, especially those with UC, exhibit reduced seropositivity rates and may benefit from screening prior to the initiation of immunosuppressive therapy.

Keywords:

• Inflammatory bowel disease
• measles
• rubella
• mumps
• varicella
• immunosuppressive therapy

Author contributions

HS conceived the study, wrote the study protocol, collected the data, and wrote the manuscript. TTa collected the data and co-wrote the manuscript. MSh, YKo, TTs, ST, KH, NY, MSu, MI, KE, MO, YSa, YSh, EN, TK, HC, SOo, HK, KK, SN, SOg and FN collected the data. YS, RM, MK, YKa, TI, YKi, and AM contributed critically to discussions. All authors approved the final version of the manuscript.

Disclosure statement

HS received lecture fees from Mitsubishi Tanabe Pharma Corp., AbbVie Inc., EA Pharma Co. Ltd., Janssen Pharmaceutical K.K., Takeda Pharmaceutical Co. Ltd., and Pfizer Inc. YKa received research grants from AbbVie Inc., Daiichi Sankyo Co. Ltd., Kyowa Kirin Co. Ltd., PRECISION IBD, and Janssen Pharmaceutical K.K., and received lecture fees from Mitsubishi Tanabe Pharma Corp., and Janssen Pharmaceutical K.K. AM received research grants from Zeria Pharmaceutical Co. Ltd., JIMRO Co. Ltd., Mochida Pharmaceutical Co. Ltd., Mitsubishi Tanabe Pharma Corp., EA Pharma Co. Ltd., and Takeda Pharmaceutical Co. Ltd. and received lecture fees from EA Pharma Co. Ltd. and Takeda Pharmaceutical Co. Ltd. The remaining authors declare no conflicts of interest.

Data availability statement

The data underlying this article cannot be shared publicly given the privacy of the individuals who participated in the study. The data will be shared on reasonable request to the corresponding author.

Additional information

Funding

None declared.