ABSTRACT Background Glucagon‐like peptide‐1 (GLP‐1) receptor agonists delay gastric emptying and are used for the treatment of diabetes (DM) and obesity. Successful treatment of Helicobacter pylori ( H. pylori ) infection depends upon a precise dosing schedule. We aimed to examine the impact of GLP‐1 drugs on antibiotic treatment for H. pylori . Methods Adults with a new diagnosis of H. pylori infection who received treatment between 2014 and 2023 were identified in the Clalit Health Services database. Subjects were divided into groups based on diagnoses of DM and obesity, and exposure to GLP‐1 drugs. A 1:2 propensity‐score matched dataset was used to determine the effect of GLP‐1 drugs on eradication success. Results We identified 426 individuals who received, and 36,436 who did not receive GLP‐1 drugs. Eradication among those who did and did not receive GLP‐1 drugs was 86.6% and 83.7%, respectively ( p = 0.059 across subgroups). Eradication among those who received semaglutide was 93.8% (OR 2.78, 95% CI 1.32–5.83, p = 0.007). Eradication in subjects who received dulaglutide (88.6%) or liraglutide (81.4%) was not significantly changed. When applying a propensity‐score‐adjusted analysis, eradication remained significantly increased among individuals who received semaglutide (OR 2.89, 95% CI 1.24–6.74, p = 0.014). Additional independent predictors of successful eradication included male sex, high socioeconomic status, quadruple therapy, and older age ( p < 0.001 for all). Conclusions Co‐administration of semaglutide and antibiotics for H. pylori infection is associated with an increased likelihood of successful eradication.

Both humoral and cellular anamnestic responses are significant for protective immunity against SARS-CoV-2. In the current study, the responses in elderly people before and after a fourth vaccine dose of BNT162b2 were compared to those of individuals immunized with three vaccine doses. Although a boost effect was observed, the high response following the third administration questions the necessity of an early fourth boost.

This cohort study evaluates the response to a third and fourth SARS-CoV-2 BNT162b2 vaccine dose among individuals aged 60 years or older by evaluating antispike immunoglobulin G antibody titers before and after each dose.

Background Patients with interstitial lung disease (ILD) are at high risk of severe COVID-19 infection. Additionally, their anti-inflammatory and antifibrotic treatment may cause immunosuppression. Nevertheless, their ability to mount an adequate immune response to messenger RNA SARS-CoV-2 vaccines was not evaluated. Therefore, we aimed to evaluate the humoral response after the BNT162b2 vaccine among idiopathic pulmonary fibrosis (IPF) patients treated with antifibrotic therapy and among non-IPF ILD patients treated with anti-inflammatory therapy. Methods We conducted an observational prospective cohort study to evaluate the level of anti-spike (S-IgG) antibodies after two doses of the BNT162b2 vaccine in patients with ILD. The cohort included 40 patients with idiopathic pulmonary fibrosis (IPF) treated with anti-fibrotic therapy and 29 patients with non-IPF ILD treated with anti-inflammatory therapy. For S-IgG titer measurement, one serology test was drawn from all patients 4–6 months after the second vaccine dose. In addition a control group matched for age and sex was created from a healthy control cohort of 107 patients. The study was conducted in Rabin Medical Center (Israel) between June and August 2021. Results All patients in the anti-fibrotic arm were seropositive (40/40), corresponding to the matched control group (P = 1.0). The anti-fibrotic arm had a significantly lower median antibody titer in comparison to the matched control group (361.10 [IQR, 207–811] AU/ml vs. 820.75 [IQR, 459–1313] AU/ml; P < 0.001). Only 48.3% (14/29) of patients in the anti-inflammatory arm were seropositive in comparison to 100% (29/29) in the healthy control group (P < 0.001). The anti-inflammatory arm had a significantly lower median antibody titer in comparison to the healthy control group (39.6 [IQR, 4.25–165] AU/ml vs. 970.1 [IQR, 505–1926] AU/ml; P < 0.001). Conclusion IPF patients treated with antifibrotic therapy mount an adequate immune response after 2 doses of the BNT162b2 vaccine, and maintain a 100% seropositivity rate 4–6 months after vaccination. However, their antibody titer was reduced in comparison to a healthy control group. Among patients with non-IPF ILD treated with anti-inflammatory therapy, 48% were seronegative 4–6 months after the second vaccine dose. Moreover, treatment with rituximab caused significant immunosuppression, even in comparison to other anti-inflammatory treatments.

Objective To evaluate the durability of response 3 months after the third BNT162b2 vaccine in adults aged 60 years and older.Design Prospective cohort study.Setting Single tertiary centre.Participants Healthcare workers/family members aged ≥60 years old who received the third BNT162b2 dose.Interventions Blood samples were drawn immediately before (T0), 10–19 days (T1) and 74–103 days (T2) after the third dose.Primary and secondary outcome measures Anti-spike IgG titres were determined using a commercial assay and seropositivity was defined as ≥50 arbitrary units (AU)/mL. Neutralising antibody titres were determined at T2. Adverse events, COVID-19 infections and Clinical Frailty Scale (CFS) levels were documented.Results The analysis included 97 participants (median age, 70 years (IQR, 66–74), 58% CFS level 2). IgG titres, which increased significantly from T0 to T1 (median, 440 AU/mL (IQR, 294–923) and median, 25 429 AU/mL (IQR, 14 203–36 114), respectively; p<0.001), decreased significantly by T2, but all remained seropositive (median, 8306 AU/mL (IQR, 4595–14 701), p<0.001 vs T1). In a multivariable analysis, only time from the second vaccine was significantly associated with lower IgG levels at T2 (p=0.017). At T2, 60 patients were evaluated for neutralising antibodies; all were seropositive (median, 1294 antibody titres; IQR, 848–2072). Neutralising antibody and anti-spike IgG levels were correlated (r=0.6, p<0.001). No major adverse events or COVID-19 infections were reported.Conclusions Anti-spike IgG and neutralising antibody levels remain adequate 3 months after the third BNT162b2 vaccine in healthy adults aged ≥60 years, although the decline in IgG is concerning. A third dose of vaccine in this population should be top priority.

BACKGROUND Age and frailty are strong predictors of COVID-19 mortality. After the second BNT162b2 dose, immunity wanes faster in older ([≥]65 years) versus younger adults. The durability of response after the third vaccine is unclear. METHODS This prospective cohort study included healthcare workers/family members [≥]60 years who received a third BNT162b2 dose. Blood samples were drawn immediately before (T0), 10-19 (T1), and 74-103 (T2) days after the third dose. Antispike IgG titers were determined using a commercial assay, seropositivity was defined as [≥]50 AU/mL. Neutralizing antibody titers were determined at T2. Adverse events, COVID-19 infections, and clinical frailty scale (CFS) levels were documented. RESULTS The analysis included 97 participants (median age, 70 years [IQR, 66-74], 61% women, 58% CFS level 2). IgG titers, which increased significantly from T0 to T1 (medians, 440 AU/mL [IQR, 294-923] and 25,429 [14,203-36,114] AU/mL, respectively; P<0.001), decreased significantly by T2, but all remained seropositive (median, 8,306 AU/mL [IQR, 4595-14,701], P<0.001 vs T1). In a multivariable analysis, only time from the first vaccine was significantly associated with lower IgG levels at T2 (P=0.004). At T2, 60 patients were evaluated for neutralizing antibodies; all were seropositive (median, 1,294 antibody titer [IQR, 848-2,072]). Neutralizing antibody and antispike IgG levels were correlated (R=0.6, P<0.001). No major adverse events or COVID-19 infections were reported. CONCLUSIONS Antispike IgG and neutralizing antibodies levels remain adequate 3 months after the third BNT162b2 vaccine in healthy adults [≥]60 years, although the decline in IgG is concerning. A third vaccine dose in this population should be top priority.

AbstractBackgroundAge/frailty are strong predictors of COVID-19 mortality. After the second BNT162b2 dose, immunity wanes faster in older (≥65 years) versus younger adults. The durability of response after the third vaccine is unclear.MethodsThis prospective cohort study included healthcare workers/family members≥60 years who received a third BNT162b2 dose. Blood samples were drawn immediately before (T0), 10□19 (T1), and 74□103 (T2) days after the third dose. Anti-spike IgG titers were determined using a commercial assay, seropositivity was defined as≥50 AU/mL. Neutralising antibody titres were determined at T2. Adverse events, COVID-19 infections, and clinical frailty scale (CFS) levels were documented.FindingsThe analysis included 97 participants (median age, 70 years [IQR, 66□74], 58% CFS level 2). IgG titres, which increased significantly from T0 to T1 (medians, 440 AU/mL [IQR, 294□923] and 25,429 [14203□36114] AU/mL, respectively; p<0·001), decreased significantly by T2, but all remained seropositive (median, 8306 AU/mL [IQR, 4595□14701], p<0·001 vs T1). In a multivariable analysis, only time from the first vaccine was significantly associated with lower IgG levels at T2 (p=0·004). At T2, 60 patients were evaluated for neutralising antibodies; all were seropositive (median, 1294 antibody titre [IQR, 848□2072]). Neutralising antibody and anti-spike IgG levels were correlated (R=0·6, p<0·001). No major adverse events or COVID-19 infections were reported.InterpretationAnti-spike IgG and neutralising antibody levels remain adequate 3 months after the third BNT162b2 vaccine in healthy adults≥60 years, although the decline in IgG is concerning. A third vaccine dose in this population should be top priority.FundingNo external funding.Research in contextEvidence before this studyWe searched PubMed on Aug 1, 2021, for published research articles with no date restrictions, using the search terms of “SARS-Cov-2”, “COVID-19”, “vaccine”, “dose”, “antibody response”, and “adults” with English as a filter. Several studies were identified that investigated waning of immunity in healthy adults. It is well established through epidemiology and serology studies that in healthy adults, the protection conferred by the BNT162b2 messenger RNA (mRNA) vaccine (Pfizer/BioNtech) wanes significantly after several months. Studies have also shown that the immune response to the vaccine varies with age, and that after the second dose of the BNT162b2 vaccine, the older adult population (65-85 years of age) typically has a lower immune response (as reflected in an analysis of anti-spike IgG antibodies and neutralising antibody titres), than younger adults (18-55 years of age), and that the immunity wanes in all age groups within several months.Added value of this studyThis is, to our knowledge, the first study that examined anti-spike IgG and neutralising antibody titres three months after the third BNT162b2 vaccine dose. The study has demonstrated that three months after that dose, participants, who were healthy adults aged 60 years and older, remained anti-spike IgG seropositive, although a significant decrease in anti-spike IgG titres was observed (compared to two weeks after the third dose). In addition, a statistically significant correlation was observed between the neutralising antibody titres and the anti-spike IgG titres, and all participants were seropositive for neutralising antibodies three months after the third dose. Also, no major adverse events or COVID-19 infections were reported.Implications of all the available evidenceAs our data suggest that a third dose of the BNT162b2 vaccine is effective in maintaining adequate immune response against COVID-19 for at least several months in healthy adults aged 60 years and older, and as it is well established that older adults are at higher risk of severe COVID-19 disease and COVID-19 mortality, providing a third dose to this population should be a top priority. Our data also highlight that understanding the waning of the immune response in other age groups is key for making evidence-based policies regarding booster vaccinations for the population at large.

This study assesses antispike (anti-S) IgG antibody titers before and after a third BNT162b2 dose (booster) in individuals aged 60 years and older in Israel.