Impact of SARS-CoV-2 vaccination in inflammatory bowel disease patients with different biological agents: a systematic review and meta-analysis

Background: there are concerns regarding the effect of bi-ological agents on SARS-CoV-2 vaccination in patients with inflammatory bowel disease (IBD). A systematic review and meta-analysis was performed about the serological respons-es, breakthrough infections and clinical relapse of IBD pa-tients treated with biological agents following SARS-CoV-2 vaccination. Methods: electronic databases were searched to identify relevant studies. Primary outcomes were the pooled sero-conversion rates, breakthrough infection rates and clinical relapse rates after SARS-CoV-2 vaccination in IBD patients treated with biological agents. Secondary outcomes were the comparison of seroconversion rates, breakthrough infec-tion rates and clinical relapse rates in IBD patients treated with biological agents and control cohort after SARS-CoV-2 vaccination. Results: thirty-five studies were included in this meta -analy-sis. A high percentage of seroconversion (96.6 %, 99 % and 99.2 %) was achieved in IBD patients treated with anti-TNF-a therapy, vedolizumab and ustekinumab after SARS-CoV-2 vaccination, respectively. The pooled breakthrough infec-tion rate was 2.5 % and 3.9 % in IBD patients treated with anti-TNF-a therapy and vedolizumab, respectively. The break-through infection rate in IBD patients treated with anti-TNF-a therapy was significantly lower than in the control cohort (RR 0.178, 95 % CI: 0.084-0.378). The pooled clinical relapse rate in IBD patients treated with anti-TNF-a therapy, vedolizumab and ustekinumab was 6.9 %, 5.4 % and 5.3 %, respectively. Conclusion: the overall seroconversion rate after SARS-CoV-2 vaccination in IBD patients treated with biological agents is high. The overall breakthrough infection rate and clinical relapse rate in IBD patients treated with biological agents were low.