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

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2 Mins
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. Kappelman2
Disclosure:

Dr Ungaro has received grant support from an NIH K23 Career Development Award (K23KD111995-01A1); has served on the advisory board or as a consultant for Eli Lilly, Janssen, Pfizer, and Takeda; and has received research support from AbbVie, Boehringer Ingelheim, and Pfizer. Dr Brenner has received a grant from the National Institutes of Health (NIH). Dr Gearry has received speaker fees and/or served on scientific advisory boards for AbbVie and Janssen. Dr Kaplan has received honoraria for speaking or consultancy from Abbvie, Janssen, Pfizer, and Takeda; has received research support from Ferring, Janssen, Abbvie, GlaxoSmithKline, Merck, and Shire; and shares ownership of a patent (TREATMENT OF INFLAMMATORY DISORDERS, AUTOIMMUNE DISEASE, AND PBC. UTI Limited Partnership, assignee. Patent WO2019046959A1. PCT/CA2018/051098. 7 Sept. 2018). Ms Kissous-Hunt has received speaker/consultant fees for Abbvie, Janssen, and Takeda. Dr Lewis has received personal fees from Johnson & Johnson, Takeda, Eli Lilly, Samsung Bioepis, UCB, Bristol-Myers Squibb, Nestlé Health Science, Bridge Biotherapeutics, Celgene, Merck, Pfizer, Gilead, Arena Parmaceuticals, and Protagonist Therapeutics; grants from Takeda, AbbVie, Janssen, and Nestlé Health Science; nonfinancial support from AbbVie and Janssen; and other support from Takeda and Pfizer, outside the submitted work. Dr Ng has received honoraria for speaking or consultancy from Abbvie, Janssen, Ferring, Tillotts, and Takeda; and has received research support from Ferring and Abbvie. Dr Rahier has received lecture fees from AbbVie, MSD, Takeda, Pfizer, Ferring, and Falk; consulting fees from AbbVie, Takeda, Hospira, Mundipharma, MSD, Pfizer, GlaxoSmithKline, and Amgen; and research support from Takeda and AbbVie. Dr Reinisch has received speaker fees from Abbott Laboratories, Abbvie, Aesca, Aptalis, Astellas, Centocor, Celltrion, Danone Austria, Elan, Falk Pharma GmbH, Ferring, Immundiagnostik, Mitsubishi Tanabe Pharma Corporation, MSD, Otsuka, PDL, Pharmacosmos, PLS Education, Schering-Plough, Shire, Takeda, Therakos, Vifor, and Yakult; has been a consultant for Abbott Laboratories, Abbvie, Aesca, Algernon, Amgen, AM Pharma, AMT, AOP Orphan, Arena Pharmaceuticals, Astellas, AstraZeneca, Avaxia, Roland Berger GmBH, Bioclinica, Biogen IDEC, Boehringer-Ingelheim, Bristol-Myers Squibb, Cellerix, Chemocentryx, Celgene, Centocor, Celltrion, Covance, Danone Austria, DSM, Elan, Eli Lilly, Ernst & Young, Falk Pharma GmbH, Ferring, Galapagos, Genentech, Gilead, Grünenthal, ICON, Index Pharma, Inova, Intrinsic Imaging,  Janssen, Johnson & Johnson, Kyowa Hakko Kirin Pharma, Lipid Therapeutics, LivaNova, Mallinckrodt, Medahead, MedImmune, Millenium, Mitsubishi Tanabe Pharma Corporation, MSD, Nash Pharmaceuticals, Nestlé, Nippon Kayaku, Novartis, Ocera, OMass, Otsuka, Parexel, PDL, Periconsulting, Pharmacosmos, Philip Morris Institute, Pfizer, Procter & Gamble, Prometheus, Protagonist, Provention, Robarts Clinical Trial, Sandoz, Schering-Plough, Second Genome, Seres Therapeutics, Setpointmedical, Sigmoid, Sublimity, Takeda, Therakos, Theravance, Tigenix, UCB, Vifor, Zealand, Zyngenia, and 4SC; has served on the advisory board for Abbott Laboratories, Abbvie, Aesca, Amgen, AM Pharma, Astellas, Astra Zeneca, Avaxia, Biogen IDEC, Boehringer-Ingelheim, Bristol-Myers Squibb, Cellerix, Chemocentryx, Celgene, Centocor, Celltrion, Danone Austria, DSM, Elan, Ferring, Galapagos, Genentech, Grünenthal, Inova, Janssen, Johnson & Johnson, Kyowa Hakko Kirin Pharma, Lipid Therapeutics, MedImmune, Millenium, Mitsubishi Tanabe Pharma Corporation, MSD, Nestle, Novartis, Ocera, Otsuka, PDL, Pharmacosmos, Pfizer, Procter & Gamble, Prometheus, Sandoz, Schering-Plough, Second Genome, Setpointmedical, Takeda, Therakos, Tigenix, UCB, Zealand, Zyngenia, and 4SC; and has received research funding from Abbott Laboratories, Abbvie, Aesca, Centocor, Falk Pharma GmbH, Immundiagnsotik, and MSD. Dr Ruemmele has received consultating fees, research grants, or honoraria from Janssen, Pfizer, Abbvie, Takeda, Celgene, Nestlé Health Science, and Nestlé Nutrition Institute. Dr Steinwurz has received speaker and consulting fees from AbbVie, Eurofarma, Ferring, Janssen, Pfizer, Sanofi, Takeda, and UCB. Dr Colombel has received research grants from AbbVie, Janssen, and Takeda; speaker fees from AbbVie, Amgen, Allergan, Ferring Pharmaceuticals, Shire, and Takeda; consulting fees from AbbVie, Amgen, Arena Pharmaceuticals, Boehringer Ingelheim, Celgene Corporation, Celltrion, Eli Lilly, Enterome, Ferring Pharmaceuticals, Genentech, Janssen, Landos, Ipsen, Medimmune, Merck, Novartis, Pfizer, Shire, Takeda, Tigenix, and Viela Bio; and holds stock options in Intestinal Biotech Development and Genfit. Dr Kappelman has received consulting fees for Abbvie, Janssen, and Takeda; is a shareholder in Johnson & Johnson; and has received research support from Abbvie and Janssen. The other authors have declared no conflicts of interest.

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).

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.

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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.