Measles Vaccine Administered to a Crohnʼs Disease Patient Receiving Vedolizumab

Abstract

Introduction: Patients with IBD on immunosuppressive therapy (ISS) with thiopurines, methotrexate or anti-TNF biologics are advised against receiving live virus vaccines due to concern about infections. In addition, it is known that there is an attenuated immune response to vaccines in patients receiving immune suppression. Vedolizumab is a gut-selective α4β7 anti- integrin monoclonal antibody approved by the FDA for the treatment of moderately to severely active Crohn's disease and ulcerative colitis. We report a case of a patient successfully vaccinated against measles virus while on vedolizumab therapy. Case Description: A 26 year old female with Crohn's ileocolitis was receiving vedolizumab and methotrexate 15 mg PO/week. She reported having received prior measles, mumps, rubella (MMR) vaccination in childhood. Due to a nation-wide measles resurgence, we assessed her measles titers to advise her of her risk of infection. Her measles antibody index (AI) was 0.7 (negative). We instructed her to stop the methotrexate and to continue the vedolizumab. Two weeks after stopping the methotrexate, she received the MMR vaccine. The methotrexate was restarted 4 weeks later. Measles AI 8 weeks after the MMR vaccine was 2.06 (positive). In 2 months follow up after she received the vaccine, there have been no adverse sequelae. Discussion: This case describes a novel approach to the MMR vaccination process in an IBD patient on vedolizumab with methotrexate. Although current guidelines state that MMR vaccine is contraindicated among immunocompromised IBD patients and should not be given to patients expected to start immunosuppressive agents within 6 weeks (1), these guidelines do not address organ-selective anti-integrin therapies. We believe that the gut-selective activity of vedolizumab allows for safe and effective administration of live virus vaccinations.Table 1: Summary of Measles IgG Antibody Index Before and After MMR Booster Administration