S1063 Corticosteroid Use in Inflammatory Bowel Disease (IBD) Patients May Lead to Worse IBD-Related Outcomes After COVID-19 Infection

Abstract

Introduction: There is growing but limited data on the effects COVID-19 has on the disease course of IBD. COVID-19 can enter epithelial cells of the gut via ACE receptors causing cell dysfunction, inflammation, and dysbiosis. Thus, we set out to evaluate IBD outcomes during and three months after COVID-19 infection. Methods: We performed a retrospective case series comparing IBD patients in remission versus not in remission diagnosed with COVID-19 seen in a single tertiary care center from March 2020 to March 2021. COVID-19 diagnosis was made by positive rapid antigen and/or PCR. We analyzed demographics, medications, need for hospitalization, changes to immunosuppressive therapy, and IBD severity and remission status noted by endoscopic scoring or Physician Global Assessment at the time of COVID-19 diagnosis and 3 months post infection. Results: We identified 57 IBD patients, 30 in remission and 27 not in remission, diagnosed with COVID-19. Comparison of baseline characteristics and COVID-19 and IBD related outcomes are noted in Table. Patients not in remission were more likely to be on steroids, including prednisone and budesonide, and biologics (0% vs 40.7%, p=0.00001; 73.3% vs 96.3%, p=0.03). Patients not in remission were significantly more likely to need escalation in treatment (OR 15.08; CI 2.98-76.3, p=0.001) and had more IBD related hospitalization and surgery at 3 months compared to patients in remission (18.5% vs 0%, p=0.02). We then excluded patients who had changes in IBD medications 90 days prior to COVID-19 diagnosis and found there was still an increased risk for treatment escalation (OR 7, CI 1.27-38.58, p=0.0254). Additionally, patients not in remission on steroids had an increased risk of escalation of IBD related medications, hospitalization, and surgeries than patients not in remission who were not on steroids (OR 12, CI 1.76-81.7, p=0.0111). Conclusion: Our study suggests COVID-19 likely has minimal impact on the clinical course of IBD patients in remission. It remains unclear what the effects are on those not in remission, especially those on corticosteroids. Corticosteroid use is associated with impaired immune response and may lead to dysbiosis by downregulation of protective mucin gene expression as shown in animal models. Thus, infection with COVID-19 in patients on steroids may contribute to an increased risk of dysbiosis and subsequent disease flare. Further study is warranted to study the effects of steroids on IBD related outcomes in patient with COVID-19 infection. Table 1. - Comparison of IBD related outcomes in patients in remission versus those with active disease at time of COVID-19 diagnosis and 3 months afterwards Remission (SD)N = 30 Not in remission (SD)N = 27 P-value Demographics Age 40.2 (16.3) 35.3 (13.7) 0.25 Sex Male 46.7% 33.3% 0.42 Female 53.3% 66.7% 0.42 Race White 70% 74% 0.78 Black 20% 18.5% 1.00 Asian 10% 3.7% 0.61 Hispanic 0% 3.7% 0.47 BMI 26.2 (5.6) 24.8 (4.0) 0.36 Comorbidities Organ transplant 3.3% 7.4% 0.60 Cardiovascular disease 13.3% 11.1% 1.00 Diabetes 3.3% 3.7% 1.00 Chronic lung disease 0% 3.7% 0.47 HTN 10% 7.4% 1.00 Current malignancy 3.3% 0% 1.00 CKD 3.3% 7.4% 0.60 Tobacco use 3.3% 3.7% 1.00 Chronic liver disease 20% 14.8% 0.73 IBD Characteristics Crohn's disease 73.3% 63.0% 0.57 Ulcerative colitis 26.7% 37% 0.57 Activity Mild Moderate Severe 14.8%77.8%7.4% IBD medication use None 6.7% 0% 0.49 5-ASA 23.3% 14.8% 0.51 Immunomodulator 6MP/AZA 3.3% 11.1% 0.34 MTX 10% 7.4% 1.00 Corticosteroids 0% 40.7% 0.00001 Budesonide 0% 18.5% 0.02 Prednisone 0% 22.2% 0.01 Biologics 73.3% 96.3% 0.03 Vedolizumab 16.7% 22.2% 0.74 Anti-TNF 43.3% 51.9% 0.60 Ustekinumab 13.3% 22.2% 0.49 Tofacitinib 0% 0% 1.00 COVID-19 Outcomes Hospitalization 13.3% 7.4% 0.67 ICU with intubation 0% 0% 1.00 Any COVID-19 therapy 3.3% 14.8% 0.18 Death 0% 0% 1.00 IBD medications held 13.3% 29.6% 0.13 IBD Outcomes at 3 months Experienced IBD flare 10% 51.8% 0.005 Escalation of immunosuppression 10% 44.4% 0.00319 Initiation of new steroid therapy 6.7% 22.2% 0.19 IBD related hospitalization/surgery 0% 18.5% 0.02