Corticosteroids, but not TNF Antagonists, Associate With Adverse COVID-19 Outcomes in Patients With Inflammatory Bowel Diseases

Increasing age, comorbidities, and use of corticosteroids and other anti-inflammatory agents correlated with severe COVID-19 in patients with inflammatory bowel diseases (IBD), whereas treatment with tumor necrosis factor (TNF) antagonists did not, researchers report in Gastroenterology.

Corticosteroids, immunomodulators (thiopurines, methotrexate), and biologic agents (TNF antagonists such as infliximab) are commonly used to treat chronic auto-inflammatory conditions and been associated with higher rates of serious viral and bacterial infections, including influenza and pneumonia. Little is known about the effects of COVID-19 on patients with these diseases, including IBD—particularly those who require systemic immunosuppressant medications.

Erica Brenner et al analyzed 525 IBD cases in the new Surveillance Epidemiology of Coronavirus Under Research Exclusion for Inflammatory Bowel Disease (SECURE-IBD) database, comprising data from 33 countries and 28 states (see map). Most of the patients had Crohn’s disease (59.4%), and 58.9% of cases had IBD in remission.

The authors aimed to identify factors associated with severe COVID-19, defined as admission to an intensive care unit, use of a ventilator, or death.

Risk factors for severe COVID-19 among IBD patients included use of systemic corticosteroids (adjusted odds ratio, 6.9), use of sulfasalazine or 5-aminosalicylate (adjusted odds ratio, 3.1), 2 or more comorbidities (adjusted odds ratio, 2.9), and increasing age (adjusted odds ratio, 1.04).

Thirty-seven patients (7%) had severe COVID-19, 161 patients (31%) were hospitalized, and 16 patients died (3% case fatality rate). Eight deaths (50%) occurred in patients ≥ 70 years of age and there were no deaths in patients < 30 years old. Most patients who died had comorbidities, including 8 with cardiovascular disease. Age-standardized mortality ratios for patients with IBD were 1.8 in China, 1.5 in Italy, and 1.7 in the United States.

Brenner et al conclude that use of TNF antagonists does not appear to be associated with severe COVID-19. Corticosteroids are not beneficial, and may even be harmful, in the treatment of coronavirus and similar viruses (MERS, SARS, etc).