Serologic Response and Safety after a Third Dose of the COVID-19 BNT162b2 Vaccine in Patients with Inflammatory Bowel Diseases

on behalf of the REsponses to COVid-19 vaccinE IsRaeli IBD group [RECOVERI]

Research output: Contribution to journalArticlepeer-review


Vaccines are pivotal for control of the coronavirus disease (COVID-19) pandemic. Patients with inflammatory bowel diseases (IBDs) treated with antitumor necrosis factor (TNF)-α have lower serologic response after two COVID-19 vaccine doses. Data regarding a third vaccine dose are scarce. An Israeli multicenter prospective observational study recruited 319 subjects: 220 with IBD (79 treated with anti-TNFα) and 99 healthy control (HC) participants. All patients received two mRNA-BNT162b2 vaccines (Pfizer/BioNTech), 80% of whom received a third vaccine dose. Evaluation included disease activity, anti-spike (S) and nucleocapsid (N) antibody levels, anti-TNFα drug levels, and adverse events (AEs). All participants showed significant serologic response one month after receiving a third dose. However, three months later, the anti-S levels decreased significantly in patients treated with anti-TNFα compared with the non-anti-TNFα and HC groups. A correlation between serologic response to the third vaccine dose and anti-TNF drug levels was not found. No significant AE or IBD exacerbation was observed. Importantly, lower serologic response after the third vaccine dose predicted infection. A third dose of BNT162b2 is effective and safe in patients with IBD. Lower serologic response predicted infection, even in seropositive subjects. Lower serologic responses and their rapid decline suggest a fourth vaccine dose in this patient population.

Original languageEnglish
Article number1263
Issue number7
StatePublished - Jul 2023


FundersFunder number
Crohn’s and Colitis Foundation of Israel
European Federation of Crohn’s and Colitis Associations
Bristol-Myers Squibb
Leona M. and Harry B. Helmsley Charitable TrustG-2101-04950
Leona M. and Harry B. Helmsley Charitable Trust


    • BNT162b2 vaccine
    • COVID-19
    • anti-TNFα
    • inflammatory bowel diseases


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