2019 novel coronavirus disease (COVID‐19) in patients with inflammatory bowel diseases

Abstract

Background: Data on patients with inflammatory bowel diseases (IBD) who have had 2019 novel coronavirus (SARS-CoV-2) disease (COVID-19) are needed.Aim: To report the clinical characteristics, including gastrointestinal symptoms, of COVID-19 in IBD patients, and to assess the risk of COVID-19 in IBD. Methods:This case series included consecutive IBD patients with laboratory-confirmed COVID-19. Age-adjusted cumulative incidences were compared with the general population in the Madrid region.Results: Through April 8, 12 of 1918 IBD patients were diagnosed with COVID-19. The average age was 52 years, 75% of the patients were female and 58.3% had Crohn's disease. Seven patients (58%) were on maintenance treatment with immunomodulators/biologics, of these four with combined therapy (33%). Eight patients (66%) required hospitalisation (one intensive care unit admission, and two deaths), and four patients were isolated at home. Nine patients had diarrhoea ranging between 4 and 10 loose stools per day (mean 5.4, SD 1.6). In five patients (42%) diarrhoea was a presenting symptom. In two patients, diarrhoea was the only symptom at debut. Cumulative incidence of COVID-19 was 6.2 per 1000 IBD patients. IBD patients had a lower adjusted incidence ratio of COVID-19 (OR 0.74, 95% CI 0.70-0.77; P < 0.001), and a similar associated mortality ratio (OR 0.95, 95% CI: 0.84-1.06; P = 0.36), compared with the general population.Conclusions: IBD patients do not have an increased risk of COVID-19 and associated mortality compared with the general population. In many IBD patients, diarrhoea was a presenting symptom, and sometimes, was the only symptom at onset of COVID-19. IMM treatment, n (%) 559 (29.1) Azathioprine, n (%) 353 (63.1) Mercaptopurine, n (%) 105 (18.8) Methotrexate, n (%) 90 (16.1) Tofacitinib*, n (%) 6 (1.1) Tacrolimus, n (%) 2 (0.3) Mycophenolate, n (%) 3 (0.5) Biological treatment, n (%) 301 (15.7) Infliximab, n (%) 110 (36.5) Adalimumab, n (%) 119 (39.5) Golimumab, n (%) 31 (10.3) Vedolizumab, n (%) 18 (6.0) Ustekinumab, n (%) 23 (7.6) Biological + IMM treatment, n (%) 157 (8.2) IMM alone, n (%) 402 (20.9) Biologics alone n (%) 144 (7.5) Disease location (L): L1 terminal ileum, L2 colon, L3 ileocolon, L4 upper gastrointestinal tract; Disease behaviour (B): B1 nonstricturing nonpenetrating; B2 stricturing, B3 penetrating. IMM: immunomodulator; Tofacitinib* is a JAKinase inhibitor not similar to conventional IMM. Abbreviations: IQR, interquartile range; Montreal classification' of Crohn's disease (CD); SD, standard deviation; UC, ulcerative colitis.

Letter: severe COVID‐19 infection and biologic therapies—a cohort study of 7 808 patients in France

“…Our evaluation of standardised hospitalisations, ICU transfers and mortality ratios suggested (after post hoc analysis), no significant excess of these features in patients with COVID-19 who were receiving biologics. These results are consistent with earlier reports 1,8 and reinforce the message that biologics can usually be safely continued.…”

“…We note the encouraging results reports by Taxonera and colleagues regarding Coronavirus disease 2019 in patients with inflammatory bowel disease (IBD). 1 Patients receiving biologics are at higher risk of developing serious infectious adverse events. 2,3 Therefore, we conducted a multicentre observational study to determine the impact of biologics on the rate of hospitalisations, intensive care unit (ICU) admissions and deaths related to COVID-19.…”

Letter: severe COVID‐19 infection and biologic therapies—a cohort study of 7808 patients in France. Authors' reply

“…The authors' declarations of personal and financial interests are unchanged from those in the original article. 2…”

“…4 In our case series of COVID-19 in IBD, five of 12 patients were receiving at least one biologic (one adalimumab, one adalimumab + methotrexate, one golimumab + methotrexate, one ustekinumab + mercaptopurine and one vedolizumab + methotrexate). 2 Of these, three had mild symptoms and self-isolated at home. The remaining two patients were hospitalised due to bilateral pneumonia but progressed favourably without requiring ICU admission.…”

“…We thank Bataille et al for their comments and interest in our case series reporting the incidence and clinical characteristics of COVID-19 among IBD patients in an IBD Unit in Madrid. 1,2 Bataille et al reported new data from a multicentre observational study that aimed to determine the impact of biologics on the rate of hospitalisations, intensive care unit (ICU) admissions and deaths related to COVID-19 in patients with immune-mediated inflammatory diseases (IMIDs). The authors found an excess in the rate of hospitalisations among patients aged 20-40 years receiving biologics, but this excess was mainly attributable to a flare of the underlying IMID.…”