Among patients with inflammatory bowels diseases (IBD), older age, increased number of comorbidities, and use of systemic corticosteroids are strong risk factors for adverse outcomes from COVID-19, researchers report in the September issue of Gastroenterology. Maintenance of remission with steroid-sparing treatments is therefore important in management of patients with IBD during this pandemic. The researchers also found that TNF antagonist therapy was not associated with severe COVID-19, providing reassurance that IBD patients can continue this treatment.
Corticosteroids, immunomodulators (thiopurines, methotrexate), biologic agents, and janus-kinase (JAK) inhibitors, commonly used to treat chronic auto-inflammatory conditions, have been associated with higher rates of serious viral and bacterial infections. However, some forms of immune suppression might reduce the excessive immune response, or cytokine storm, characteristic of severe COVID-19 infection and thereby reduce mortality. COVID-19 also has gastrointestinal effects.
Erica J Brenner et al studied the course of COVID-19 and risk factors for adverse outcomes in a large cohort of patients with IBD, using data from an international registry. The authors analyzed data from 525 patients, from 33 countries (median age 43 years, 53% men), with IBD and COVID-19 listed in the Surveillance Epidemiology of Coronavirus Under Research Exclusion for IBD (SECURE-IBD, see map).
Brenner et al found that 37 patients (7%) had severe COVID-19, 161 patients (31%) were hospitalized, and 16 patients died (3% case fatality rate). No deaths occurred in the 29 reported cases of patients younger than 20 years old. Half of deaths occurred in patients older than 70 years.
Risk factors for severe COVID-19 among patients with IBD included increasing age (adjusted odds ratio [aOR], 1.04; 95% CI, 1.01–1.02), 2 or more comorbidities (aOR, 2.9; 95% CI, 1.1–7.8), use of systemic corticosteroids (aOR, 6.9; 95% CI, 2.3–20.5), and use of sulfasalazine or 5-aminosalicylate (5-ASA) (aOR, 3.1; 95% CI, 1.3–7.7).
Treatment with a tumor necrosis factor antagonist was not associated with severe COVID-19 (aOR, 0.9; 95% CI, 0.4–2.2). Based on this aOR, Brenner et al suggest that that TNF antagonist monotherapy might even have a protective effect against severe COVID-19. The authors also mentioned that 51/55 patients (93%) treated with anti-interleukin12/23 required only outpatient care and none died.