P059 Corticosteroids, Aminosalicylates and Gastrointestinal Symptoms Are Associated With the Need of Hospitalization in Patients With Inflammatory Bowel Diseases and COVID-19

Abstract

BACKGROUND: Current evidence suggests that patients with inflammatory bowel diseases (IBD) do not have an increased risk of infection of SARS-CoV-2 or the development of COVID-19 complications. Recent data reinforce that poor outcomes in IBD patients are associated with active intestinal disease, comorbidities and older age. The effect of immunosuppressant medications on the severity of COVID-19 disease still unclear. Our aim was to describe the characteristics of patients with IBD with a positive test for SARS-CoV-2 and to evaluate the association between clinical characteristics, IBD therapies and COVID-19 symptoms with the need of hospitalization in Brazil. METHODS: The Brazilian IBD Study Group (Grupo de Estudos da Doença Inflamatória Intestinal Brasileiro - GEDIIB) developed a 19-question online survey for IBD patients with confirmed COVID-19 assessing clinical characteristics, IBD treatment, medications used for COVID-19 as well as the need for hospital admission due to COVID-19. The national survey was available from June 4, 2020 to August 28, 2020. Data was exported and analyzed in SPSS Statistics 23 (IBM Corporation, Armonk, New York, United States) and a two-tailed P value of 0.05 was used for statistical significance. RESULTS: Among 74 respondents: 32.9% patients were male, the mean age was 37.67 (±12.93) years and most participants (77,0%) had no comorbidities considered risk factors for severe COVID-19. Most participants had Crohn's disease (72.6%) and 46.4% reported IBD symptoms at the time of COVID-19 diagnosis. Biologic therapies were the most common reported treatment (67.7%), 34% of them in combination with immunomodulators. The most common class of biologic medication utilized was TNF-antagonist (72.0%). Immunomodulators were the second most frequent IBD treatment (37.8%), followed by aminosalicylates (31.1%) and corticosteroids (28.4%). The proportion of IBD patients who stopped therapy during COVID-19 was 64.0% for biologics, 53,6% for immunomodulators and 9.5% for corticosteroids. Median duration of COVID-19 symptoms was 13.5 (8–20) days. Gastrointestinal symptoms attributable to COVID-19 were reported by 52.7% of participants and the most common symptom was diarrhea (92.3%). Clinical complications from COVID-19, defined as thromboembolic event, gastrointestinal bleeding, renal or cardiac disfunction and/or other unspecified complications, were reported by 21.6% of participants. Gastrointestinal bleeding was the most prevalent (43.8%) reported complication. Overall, 50% of participants visited the emergency room and 17.6% required hospitalization. The frequencies of aminosalicylates and corticosteroid therapy were significantly higher in patients requiring hospitalization (respectively, 61.5% vs 24.6%, P = 0.009 and 61.5% vs 21.3%, P = 0.003) while no significant differences were observed for biologics or immunomodulators. In hospitalized patients the symptoms of COVID-19 were longer (20 days, IC 18–21 vs 10 days, IC 5–15, P = 0,0001) and the frequency of gastrointestinal symptoms attributable to COVID-19 was also higher (100% vs 42.6%, P < 0.001). CONCLUSION: Corticosteroids, aminosalicylates, prolonged COVID-19 symptoms and gastrointestinal symptoms related to COVID-19 are associated with the need of hospitalization in IBD patients with COVID-19.