C0423 - Efficacy of Pneumococcal Vaccine in Patients With Inflammatory Bowel Disease - A Propensity-Matched Analysis

Monday, October 24, 2022

3:00 PM – 5:00 PM ET

Location: Crown Ballroom

Presenting Author(s)

Aakash Desai, MD

MetroHealth Medical Center/Case Western Reserve University
Cleveland, OH

Aakash Desai, MD¹, Jana G. Hashash, MD, MSc², Francis A. Farraye, MD, MSc³, Gursimran S. Kochhar, MD⁴
¹MetroHealth Medical Center/Case Western Reserve University, Cleveland, OH; ²Mayo Clinic Florida, Jacksonville, FL; ³Mayo Clinic, Jacksonville, FL; ⁴Allegheny Health Network, Pittsburgh, PA

Introduction: Studies in patients with inflammatory bowel disease (IBD) have shown decreased immunogenicity from vaccines compared to the general population. Patients with IBD should receive the 13-valent pneumococcal conjugate vaccine (PCV13) followed by the 23-valent pneumococcal polysaccharide vaccine (PPSV23) after 8 weeks and a single booster of PPSV23, 5 years later. The primary aim of our research is to assess the efficacy of the pneumococcal vaccines in IBD patients.

Methods: A retrospective cohort study was conducted using TriNetX, a multi-institutional database of more than 70 million patients from 49 healthcare organizations in the USA. The risk of pneumococcal disease (PD) in IBD patients who received PCV13, PPS23, PCV13 + PPSV23 and booster dose (PCV13 + two doses of PPSV23) was compared to unvaccinated IBD patients. 1:1 propensity-matching for age, gender, ethnicity, and known risk factors for pneumococcal disease was performed. Adverse outcomes of pneumonia assessed were hospitalization, risk of ICU admission, and endotracheal intubation in patients within 30 days and 90-day mortality. Adjusted odds ratios (aOR) with 95% confidence interval (CI) were calculated to express the risk of each adverse event.

Results: A total of 185,564 patients with IBD were identified in the dataset. A total of 20,850 (11.5%) had received either PCV13, PPSV23 or a combination of PCV13 and PPSV23. The risk of PD was decreased in IBD cohort with PCV13 + PPSV23 (aOR 0.8, 95% CI: 0.71-0.92), PPSV23 (0.85, 0.75-0.96) and booster dose (0.36, 0.22-0.57) compared to the unvaccinated cohort (Table 1). The vaccinated IBD cohort had a decreased risk for adverse pneumonia outcomes compared to unvaccinated cohort (Table 1). There was no difference in the risk of PD between vaccinated IBD and non-IBD cohort after PCV13+PPSV23 (aOR 0.95, 95% CI: 0.83-1.09), PCV13 (1.06, 0.92-1.23) and PPSV23 (1.01, 0.89-1.15). The risk of adverse pneumonia outcomes was also similar across all vaccination groups. Patients with IBD on immunomodulator therapy had a higher risk of PD than those on 5-ASA therapy (aOR 1.96, 95% CI; 1.51-2.55) however there was no difference in risk in patients on TNFi or non-TNFi biologic agents.

Discussion: In conclusion, both PCV13 & PPSV23 confer protection to patients with IBD and protect them from severe disease-related outcomes. Immunomodulator therapy, despite vaccination status, confers a higher risk of developing pneumococcal disease.

Figure: Risk of composite of adverse pneumonia outcomes between IBD and non-IBD cohort based on type of pneumococcal vaccine. Composite outcomes include hospitalization, ICU care, intubation and 30-day mortality.

Outcome	Vaccine (%)	Unvaccinated (%)	OR	95% CI
	PPSV23 + PCV13

Composite	7.2	14.2	0.46	0.30 – 0.71
Hospitalization	25.4	35.4	0.62	0.47 – 0.82
ICU care	5.1	9.9	0.49	0.30 – 0.81
Intubation	2.8	5.5	0.5	0.26 – 0.97
90-day mortality	3.7	9.3	0.37	0.21 – 0.66

	PCV13

Composite	2.5	11.9	0.19	0.09 – 0.38
Hospitalization	8.1	26.6	0.25	0.16 – 0.38
ICU care	2.5	8.6	0.27	0.13 – 0.56
Intubation	2.5	3.3	0.76	0.33 – 1.76
90-day mortality	0	7.1	N/A	N/A

	PPSV23

Composite	2.2	13	0.15	0.08 – 0.29
Hospitalization	14.4	28.2	0.42	0.31 – 0.58
ICU care	2.0	9.7	0.19	0.09 – 0.38
Intubation	2.0	5.6	0.34	0.16 – 0.71
90-day mortality	2.0	6.5	0.29	0.14 – 0.61

Table: Risk of pneumonia related adverse events in patients with IBD who received a pneumococcal vaccine compared to unvaccinated patients with IBD.

Disclosures:

Aakash Desai indicated no relevant financial relationships.

Jana Hashash indicated no relevant financial relationships.

Francis Farraye: Adiso Therapeutics – DSMB. BMS – Advisory Committee/Board Member. Braintree Labs – Advisory Committee/Board Member. GSK – Advisory Committee/Board Member. IBD Educational Group – Advisory Committee/Board Member. Innovation Pharmaceuticals – Stock Options. Iterative Scopes – Advisory Committee/Board Member. Janssen – Advisory Committee/Board Member. Lilly – DSMB. Pfizer – Advisory Committee/Board Member. Sebela – Advisory Committee/Board Member. Theravance – DSMB.

Gursimran Kochhar: GIE Medical – Advisor or Review Panel Member. Lilly Pharma – Advisor or Review Panel Member.

Aakash Desai, MD¹, Jana G. Hashash, MD, MSc², Francis A. Farraye, MD, MSc³, Gursimran S. Kochhar, MD⁴. C0423 - Efficacy of Pneumococcal Vaccine in Patients With Inflammatory Bowel Disease - A Propensity-Matched Analysis, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.