Abstract
Background: Crohn’s disease (CD) and ulcerative colitis (UC) are chronic, immune-mediated inflammatory bowel diseases (IBD) affecting millions of people worldwide. IBD therapies, designed for continuous immune suppression, often render patients more susceptible to infections. The effect of the immune suppression on the risk of coronavirus disease-19 (COVID-19) is not fully determined yet. Objective: To describe COVID-19 characteristics and outcomes and to evaluate the association between IBD phenotypes, infection outcomes and immunomodulatory therapies. Methods: In this multi-center study, we prospectively followed IBD patients with proven COVID-19. De-identified data from medical charts were collected including age, gender, IBD type, IBD clinical activity, IBD treatments, comorbidities, symptoms and outcomes of COVID-19. A multivariable regression model was used to examine the effect of immunosuppressant drugs on the risk of infection by COVID-19 and the outcomes. Results: Of 144 IBD patients, 104 (72%) were CD and 40 (28%) were UC. Mean age was 32.2 ± 12.6 years. No mortalities were reported. In total, 94 patients (65.3%) received biologic therapy. Of them, 51 (54%) at escalated doses, 10 (11%) in combination with immunomodulators and 9 (10%) with concomitant corticosteroids. Disease location, behavior and activity did not correlate with the severity of COVID-19. Biologics as monotherapy or with immunomodulators or corticosteroids were not associated with more severe infection. On the contrary, patients receiving biologics had significantly milder infection course (p = 0.001) and were less likely to be hospitalized (p = 0.001). Treatment was postponed in 34.7% of patients until recovery from COVID-19, without consequent exacerbation. Conclusion: We did not witness aggravated COVID-19 outcomes in patients with IBD. Patients treated with biologics had a favorable outcome.
Highlights
Inflammatory bowel disease (IBD) is a complex, multifactorial chronic inflammatory disease of the gastrointestinal tract encompassing two main clinical entities: Crohn’s disease (CD) and ulcerative colitis (UC)
Patients with inflammatory bowel diseases (IBD) are among millions of people that have been affected by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)
16.3% of CD patients and 30% of UC patients were infected by SARS-CoV-2 while in remission, the rest were reported with moderate disease
Summary
Inflammatory bowel disease (IBD) is a complex, multifactorial chronic inflammatory disease of the gastrointestinal tract encompassing two main clinical entities: Crohn’s disease (CD) and ulcerative colitis (UC). The extensive use of these therapies among patients with IBD increases their risk of opportunistic and severe infections [1,2]. Patients with IBD are among millions of people that have been affected by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). In a recent large cohort of 5302 IBD patients only 39 (0.7%) developed COVID-19 [8] In another population-based study, patients with IBD were more likely to be hospitalized due to COVID-19; the risk of severe COVID-19 was not higher than the general population [9]. A panel of the international organization for the study of inflammatory bowel diseases (IOIBD) has recently stated that having IBD did not increase the risk of developing COVID-19 [10,11]. Crohn’s disease (CD) and ulcerative colitis (UC) are chronic, immunemediated inflammatory bowel diseases (IBD) affecting millions of people worldwide. Objective: To describe COVID-19 characteristics and outcomes and to evaluate the association between IBD phenotypes, infection outcomes and immunomodulatory therapies
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