Pediatric patients with inflammatory bowel diseases (IBD) have a low risk of severe COVID-19, even when receiving biologic and/or other immune suppressive therapies, researchers report in Clinical Gastroenterology and Hepatology. These findings support recommendations to continue maintenance IBD treatment for pediatric patients throughout the current
SARS-CoV2 enters human cells via the angiotensin-converting enzyme 2 (ACE2) receptor, which is highly expressed in the terminal ileum and colon and upregulated during inflammation. Many patients with COVID-19 develop gastrointestinal symptoms, but studies are needed to determine whether IBD patients are at risk for severe or complicated COVID-19.
An analysis of IBD patients found that older age, steroid medication, and comorbidities were risk factors for severe COVID-19, whereas patients younger than 20 years had a mild disease course.
Erica J. Brenner et al collected data on the course of COVID-19 in 209 patients with IBD from 2 international databases (the SECURE-IBD and Porto Group databases, from 23 countries). Almost half of the children had received TNF antagonist monotherapy (48%), 23% received
sulfasalazine/mesalamine, and most patients (86%) had no comorbidities. There were no deaths; 14 children (7%) were hospitalized and 2 children (1%) required mechanical ventilation. The 2 children requiring mechanical ventilation were receiving treatment with sulfasalazine/mesalamine and
developed a multi-system inflammatory syndrome and concomitant secondary infection, respectively, with positive outcomes.
Factors associated with hospitalization included comorbidities other than IBD, moderate/severe IBD disease activity, gastrointestinal symptoms, and use of sulfasalazine/mesalamine or steroids..
TNF antagonist monotherapy was associated with a decreased likelihood of hospitalization. Sulfasalazine or mesalamine use remained a risk factor after the authors adjusted for disease activity (adjusted odds ratio, 4.2, 95% CI, 1.3-14.1).
The authors state that these COVID-19 cases likely under-represent the actual case burden, since most pediatric COVID19 manifestations are mild or asymptomatic. The low observed rate of hospitalization rate is likely an overestimation of the true hospitalization rate.
The findings that sulfasalazine or mesalamine and steroid use are associated with increased risk of hospitalization, and that TNF antagonist monotherapy is associated with decreased risk, parallel findings from adult patients with IBD and COVID-19.
The authors state that the findings should provide assurance to parents of children with IBD who are considering sending them back to schools when they reopen.