Effect of SARS-CoV-2 mutant on IBD management

The COVID-19 pandemic reveals several challenges in managing inflammatory bowel disease (IBD). One of the first important considerations was the incidence and outcome of COVID-19 and the effect of immunosuppression on immunity after infection or vaccination.1Ungaro RC Burner EJ Geary RB et al.Effect of IBD on COVID-19 results: Results from international registration., 2Centers for Disease Control and PreventionAbout the virus variants that cause COVID-19. With the increasing number of cases due to the emergence of SARS-CoV-2 mutants, the question now is whether this information still applies.The SARS-CoV-2 mutant, called B.1.1.7, was first identified in the United Kingdom and is now the predominant strain. The variants are spread over more than 70 countries.2Centers for Disease Control and PreventionAbout the virus variants that cause COVID-19. Another variant B.1.351 emerged independently in South Africa, and the Brazilian variant P.1 was identified in January 2021. The UK and South African variants have a mutation (N501Y) in the receptor binding domain of spikes. Proteins reported to be associated with 40-70% higher transmissibility.3Fontanet A Autorun B Lina B Kieny MP Karim SSA Sridal D The end of the SARS-CoV-2 variant and the COVID-19 pandemic. Some early studies suggest that B.1.1.7 mortality is higher than the original strain.2Centers for Disease Control and PreventionAbout the virus variants that cause COVID-19., FourGOV.UKNERVTAG Paper B.1.1.7 on the COVID-19 variant of concern. Various protections are provided by the SARS-CoV-2 vaccine currently approved for these urgent variants.3Fontanet A Autorun B Lina B Kieny MP Karim SSA Sridal D The end of the SARS-CoV-2 variant and the COVID-19 pandemic., FiveMuiku A Valish AK Singer B et al.Neutralization of SARS-CoV-2 strain B.1.1.7 pseudovirus with BNT162b2 vaccine-induced human serum. As a result, many countries impose additional blockades, travel bans, and strict quarantine rules on those who visit these areas where the subspecies are endemic.The new variant shares the same symptoms as the first strain. However, in B.1.1.7, loss of taste and odor was observed with a slightly lower frequency.6National Bureau of StatisticsCoronavirus (COVID-19) Infection Survey: Characteristics of people tested positive for COVID-19 in the United Kingdom. It is important to note that despite evidence of increased transmissibility, there is still little evidence that this variant is associated with a more severe phenotype or increased mortality.FourGOV.UKNERVTAG Paper B.1.1.7 on the COVID-19 variant of concern. However, since the first appearance of SARS-CoV-2, advances in testing and treatment strategies for COVID-19 can confuse such observations.The emergence of SARS-CoV-2 mutants raises some questions in the IBD community. Initial experience with COVID-19 suggests that drugs used in patients with IBD do not appear to increase the risk, severity, or outcome of infection.7COVID-19: A systematic review of clinical data in patients with inflammatory bowel disease. Currently, it may not be possible to see if the same is true for new variants. In addition, further mutations in SARS-CoV-2 may occur in the future, leading to changes in infectivity, pathogenicity, and severity. It is not yet known how this will affect patients with IBD.An additional consideration to note is whether immunosuppression affects antivirals.8Wisniewski A Kirchgesner J. Sexual P et al.An increased incidence of serious systemic viral infections in patients with inflammatory bowel disease is associated with active disease and the use of thiopurine. And immune response9Alexander JL Moran GW DR style et al.SARS-CoV-2 Vaccination for Patients with Inflammatory Bowel Disease: The View of the Inflammatory Bowel Disease Section of the British Gastroenterological Society and the IBD Clinical Research Group. For patients with IBD. The combination of viral mutations and immunosuppression may be sufficient to weaken the anti-vaccine response to the point that available vaccines no longer provide meaningful anti-SARS-CoV-2 immunity, at least with respect to the form of the mutant virus. There is.Therefore, it is recommended that patients with IBD should proceed with caution even in the current pandemic. In addition, it is recommended that the effectiveness of the vaccine in the general population should be extrapolated very carefully in the immunosuppressed population. Given that there is already evidence of a low immunogenic response to new mutants with currently approved vaccines,FourGOV.UKNERVTAG Paper B.1.1.7 on the COVID-19 variant of concern. The fact that immunosuppression can further reduce immunogenicity is a source of concern for IBD patients.Despite many studies on the effects of primary sequenced SARS-CoV-2, observational prospective studies need to be developed to assess the effects of new mutants on IBD patients. It is imperative that the healthcare community facilitate ongoing research on the effectiveness of new vaccines available as they become available.The exemplary model is UK CLARITY IBD Initiative Evaluate seroconversion after SARS-CoV-2 infection in IBD patients receiving systemic anti-tumor necrosis factor therapy (infliximab) or intestinal-selective anti-α4β7 integrin therapy (vedolizumab). Facilitating such studies will allow rapid evidence-based adaptation to vaccination strategies, including vaccine selection, combination vaccines, or the use of boosters to immunize IBD patients with optimal immunity. Ensure a resilient future strategy.JPS receives lecture fees from Takeda and Janssen. TR is a research, educational grant, or speaker from AbbVie, Arena, AstraZeneca, BMS, Celgene, Ferring, Galapagos, Gilead, GSK, LabGenius, Janssen, Mylan, MSD, Novartis, Pfizer, Sandoz, Takeda, and UCB. I am receiving a consultation fee. .. CALs are from Genentech, AbbVie, Eli Lilly, Pfizer, Roche, UCB Biopharma, Sanofi Aventis, Biogen IDEC, Orion OYJ, AstraZeneca, grants and personal fees from Janssen and Takeda, individuals from Ferring and Dr Falk Pharma. I am reporting the charges. Submitted work. MJB is funded by Vifor International and Tillots Pharma in the form of research and travel funding grants. AK does not declare competing interests.References1.1.Ungaro RC Burner EJ Geary RB et al.Effect of IBD on COVID-19 results: Results from international registration.Intestines. 2020; ()2.2.Centers for Disease Control and PreventionAbout the virus variants that cause COVID-19.3.3.Fontanet A Autorun B Lina B Kieny MP Karim SSA Sridal D The end of the SARS-CoV-2 variant and the COVID-19 pandemic.The lancet. 2021; ()4.4.NERVTAG Paper B.1.1.7 on the COVID-19 variant of concern.5.5.Muiku A Valish AK Singer B et al.Neutralization of SARS-CoV-2 strain B.1.1.7 pseudovirus with BNT162b2 vaccine-induced human serum.Science. 2021; ()6.6.National Bureau of StatisticsCoronavirus (COVID-19) Infection Survey: Characteristics of people tested positive for COVID-19 in the United Kingdom.7.COVID-19: A systematic review of clinical data in patients with inflammatory bowel disease.Dig Liver Dis. 2020; 52: 1222-12278.8.Wisniewski A Kirchgesner J. Sexual P et al.An increased incidence of serious systemic viral infections in patients with inflammatory bowel disease is associated with active disease and the use of thiopurine.United European Gastroenterol J. 2019; 8: 303-3139.9.Alexander JL Moran GW DR style et al.SARS-CoV-2 Vaccination for Patients with Inflammatory Bowel Disease: The View of the Inflammatory Bowel Disease Section of the British Gastroenterological Society and the IBD Clinical Research Group.The Lancet Gastroenterol Hepator. 2021; 6: 218-224Article informationPublication historyRelease date: March 9, 2021identificationDOI: https://doi.org/10.1016/S2468-1253(21)00075-3Copyright© 2021 Elsevier Ltd. All rights reserved.ScienceDirectAccess this article on ScienceDirect Pictures Credit

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