Impact of COVID-19 on Patients with Inflammatory Bowel Disease: Update from an International Registry - European Medical Journal

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Impact of COVID-19 on Patients with Inflammatory Bowel Disease: Update from an International Registry

1 Mins
Gastroenterology
Authors:
* Ryan C. Ungaro , 1 Erica J. Brenner , 2 Richard B. Gearry , 3 Gilaad G. Kaplan , 4 Michele Kissous-Hunt , 5 James D. Lewis , 6 Siew C. Ng , 7 Jean-Francois Rahier , 8 Walter Reinisch , 9 Frank M. Ruemmele , 10 Flavio Steinwurz , 11 Fox E. Underwood , 4 Xian Zhang , Jean-Frederic Colombel , 1 Michael D. Kappelman 2

1. The Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
2. Department of Pediatric Gastroenterology, University of North Carolina Children’s Hospital, Chapel Hill, North Carolina, USA
3. Department of Medicine, University of Otago, Christchurch, New Zealand
4. Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Canada
5. Mount Sinai Medical Center, New York, New York, USA
6. The University of Pennsylvania, Philadelphia, Pennsylvania, USA
7. Department of Medicine and Therapeutics, Institute of Digestive Disease, State Key Laboratory of Digestive Disease, Li Ka Shing Institute of Health Science, The Chinese University of Hong Kong, Shatin, Hong Kong
8. Department of Gastroenterology, Université Catholique de Louvain, CHU UCL Namur, Yvoir, Belgium
9. Department Internal Medicine III, Division Gastroenterology & Hepatology, Medical University of Vienna, Vienna, Austria
10. Service de Gastroentérologie Pédiatrique, Assistance Publique Hôpitaux de Paris, Hôpital Necker–Enfants Malades, Université de Paris, Paris, France
11. Hospital Israelita Albert Einstein, São Paulo, Brazil
12. Department of Gastroenterology, University of North Carolina, Chapel Hill, North Carolina,USA
*Correspondence to [email protected]

Acknowledgements:

The authors would like to acknowledge the physicians and other healthcare providers worldwide who have reported cases to the SECURE-IBD database and the organisations who supported or promoted the SECURE-IBD database (reporter names available at www.covidibd.org/reporter-acknowledgment/). See Table S4 for organisation names).

Keywords:
Coronavirus disease (COVID-19), immunosuppression, inflammatory bowel disease (IBD).
Citation:
EMJ Gastroenterol. ;9[1]:44-46. Abstract Review No. AR1.

Each article is made available under the terms of the Creative Commons Attribution-Non Commercial 4.0 License.

BACKGROUND AND AIMS

Patients with inflammatory bowel disease (IBD) are frequently on immunosuppressive treatments that increase the risks of infection. To date, there are limited data on the disease course of coronavirus disease (COVID-19) in patients with IBD, including the impact of clinical characteristics and medications. The authors utilised the Surveillance Epidemiology of Coronavirus Under Research Exclusion for Inflammatory Bowel Disease (SECURE-IBD), an international registry of patients with IBD who have had COVID-19, to evaluate the association of demographics, clinical characteristics, and immunosuppressant treatments on COVID-19 outcomes. This work was an updated analysis of SECURE-IBD following the first publication from this database.1

MATERIALS AND METHODS

Age-standardised mortality ratios were calculated using reference populations from China, Italy, and the USA.2-4 The primary outcome was severe COVID-19, defined as a composite of intensive care unit admission, ventilator use, and/or death. Multivariable logistic regression was used to understand the independent impact of variables on severe COVID-19.

RESULTS

A total of 959 cases from 40 countries were reported (median age: 43 years; 52% male). A total of 86 patients (9%) had severe COVID-19, 320 (33%) were hospitalised, and 37 patients died (3.9% case fatality rate). Age-standardised mortality ratio for patients with IBD were 2.0 (95% confidence interval [CI]: 1.4–2.7), 1.7 (95% CI: 1.1–2.2), and 1.9 (95% CI: 1.3–2.5), relative to data from China, Italy, and the USA, respectively. On multivariable analysis, risk factors for severe COVID-19 among patients with IBD included increasing age, ≥1 comorbidities in addition to IBD, systemic corticosteroids, and sulfasalazine or 5-aminosalicylate use (Table 1). TNF antagonist treatment was not associated with severe COVID-19 (adjusted odds ratio: 0.9; 95% CI: 0.5–1.8).

Table 1: Multivariable analysis of risk factors for severe coronavirus disease (COVID-19).
5-ASA: 5-aminosalicylic acid; CI: confidence interval; IBD: inflammatory bowel disease; ICU: intensive care unit.

CONCLUSIONS

Strengths of the study included a large, international population of patients with IBD. Limitations included the fact that this was a convenience sample, with potential for reporting bias. The clinical implication of these findings is that patients with IBD who are older with multiple comorbidities, and those on systemic corticosteroids, are at higher risk of severe COVID-19. In contrast, TNF antagonists do not appear to increase the risk of poor outcomes, and these data provide reassurance that patients should continue these medications. Future research is needed to better understand the impact of other IBD medications, including different classes of biologics.

References
Brenner EJ et al. Corticosteroids, but not TNF antagonists, are associated with adverse COVID-19 outcomes in patients with inflammatory bowel diseases: results from an international registry. Gastroenterology. 2020;159(2):481-91.e3. Onder G et al. Case-fatality rate and characteristics of patients dying in relation to COVID-19 in Italy. JAMA. 2020;323(18):1775-6. Zhonghua L et al. [The epidemiological characteristics of an outbreak of 2019 novel coronavirus diseases (COVID-19) in China]. 2020;41(2):145-51. (In Chinese). Centers for Disease Control and Prevention (CDC). Daily Updates of Totals by Week and State: Provisional Death Counts for Coronavirus Disease 2019 (COVID-19). 2020. Available at: https://www.cdc.gov/nchs/nvss/vsrr/COVID19/. Last accessed: 27 October 2020.

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