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cIb4DFAYSVSpkcWsGyL24usLMwTRAescxYr8Tfue75SQG23Hoi7iL

Eligibility for VIP study

We would like to invite you to take part in VIP, a research study which looks at how patients respond to SARS-CoV-2 (COVID) vaccination whilst on certain inflammatory bowel disease (IBD) medications. We would be grateful if you would carefully read the information sheet about the study and complete your details below to determine whether you are eligible for the study.

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Eligibility version

Is this record just for testing purposes?

Yes

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Date of completing eligibility form

* must provide value

D-M-Y

Which of these hospitals are you associated with?

* must provide value

Addenbrooke's, Cambridge

Barts, London

Guy's and St Thomas' Hospital

Imperial

King's College Hospital

St George's

St Mark's Hospital (North West London)

Royal Devon & Exeter Hospital

Western General Hospital, Edinburgh

Other

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Which hospital do you attend?

Data access group

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Are you aged 18 years or over?

* must provide value

Yes

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Do you have inflammatory bowel disease (Crohn's or colitis)?

* must provide value

Yes

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What type of inflammatory bowel disease do you have?

* must provide value

Crohn's disease

Ulcerative colitis

IBD-unclassified

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Have you received one or more doses of vaccination against SARS-CoV-2 (COVID-19)?

* must provide value

Yes

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At the time of your first dose of COVID-19 vaccine were you receiving any of the following treatments by injection/infusion?

* must provide value

ustekinumab (Stelara)

vedolizumab (Entyvio)

infliximab (Remicade, Inflectra, Remsima, Zessly, Flixabi)

adalimumab (Humira, Amgevita, Hyrimoz, Imraldi, Idacio, Hulio)

golimumab (Simponi)

certolizumab (Cimzia)

methotrexate (Maxtrex, Methofill, Metoject, Ebetrex, Namaxir, Nordimet and Zlatal)

None of the above

At the time of your first dose of COVID-19 vaccine were you receiving any of the following treatments by mouth?

* must provide value

azathioprine (Imuran, Azapress)

mercaptopurine (6-MP, Hanixol, Xaluprine)

tioguanine (6-thioguanine)

methotrexate (Maxtrex, Methofill, Metoject, Ebetrex, Namaxir, Nordimet and Zlatal)

tacrolimus (Envarsus, Adoport,Prograf, Advagraf, Dalliport, Modigraf)

ciclosporin (Neoral, Vanquoral, Capimune, Capsorin, Deximune, Sandimmun)

tofacitinib (Xeljanz)

mycophenolate (MMF, Myfortic, Ceptava, CellCept)

thalidomide (Talidex)

None of the above

Were you receiving any other immunosuppressant or biologic medications not listed above at the time of your COVID-19 vaccination?

* must provide value

Yes

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Please specify what they were

* must provide value

Were you receiving any immunosuppressant or biologic medications at the time of your COVID-19 vaccination?

Yes

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Were you receiving any steroid tablets or injections at the time of your COVID-19 vaccination?

* must provide value

Yes

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Study group

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Had you been on the medications specified above for at least 12 weeks at the time of your first dose of COVID-19 vaccination?

* must provide value

Yes

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Had you had at least one dose of the medications specified above in the 16 weeks prior to your first dose of COVID-19 vaccination?

* must provide value

Yes

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When was your first dose of COVID-19 vaccination?

* must provide value

D-M-Y

Have you had your second dose of COVID-19 vaccine?

Yes

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When was your second dose of COVID-19 vaccination?

D-M-Y

We will contact you via email or phone to find out when you've had your second dose.

Is the patient able to give informed consent?

* must provide value

Yes

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Interval between doses (days)

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Interval between second dose of vaccine and eligibility visit

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Eligible

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Unfortunately you are not eligible for the study: you are under 18

Unfortunately you are not eligible for the study: you are not on one of the eligible medications and/or are on one of the excluded medications for the study

Unfortunately you are not eligible for the study: you are on an excluded medication

Unfortunately you are not eligible for the study: you had not been on your medication for long enough at the time of vaccination

Unfortunately you are not eligible for the study: you had not had a dose of medication recently enough at the time of vaccination

Unfortunately you are not eligible for the study: your vaccine doses were not between 6 and 13 weeks apart

Unfortunately you are not eligible for the study: your second vaccine dose was more than 92 days ago

Unfortunately you are not eligible for the study: your first vaccine dose was more than 13 weeks ago and you have not yet had a second dose

Unfortunately you are not eligible for the study: you have not yet had a dose of COVID-19 vaccination

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