COVID-19 in patients with inflammatory bowel disease

Anikhindi, Shrihari Anil; Kumar, Ashish; Arora, Anil

doi:10.1080/17474124.2020.1816822

Cited by 10 publications

(11 citation statements)

References 49 publications

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“…These results may be shocking, considering that glucocorticoids are, to date, the most effective treatment for this disease [Rodríguez-Baño et al, 2021;Horby et al, 2021]. However, some small series have shown that, when analyzing patients with chronic immunosuppressive medications, patients receiving glucocorticoids seemed to be at higher risk of death than those not receiving them [Ayala-Gutiérrez et al, 2021;Anikhindi et al, 2020;Pablos et al, 2020;Schulze-Koops et al, 2021]. As a matter of fact, higher mortality rates have been found even in patients with chronic inhaled glucocorticoids [Schultze et al, 2020].…”

Section: Discussionmentioning

confidence: 99%

Influence of chronic use of corticosteroids and calcineurin inhibitors on COVID-19 clinical outcomes: analysis of a nationwide registry

Calderón-Parra

Cuervas-Mons

Moreno-Torres

et al. 2022

International Journal of Infectious Diseases

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Objectives To analyze whether subgroups of immunosuppressive (IS) medications confer different outcomes in COVID-19. Methods Multicenter retrospective cohort of consecutive immunosuppressed patients (ISP) hospitalized with COVID-19 from March to July 2020. The primary outcome was in-hospital mortality. A propensity score-matched (PSM) model comparing ISP and non-ISP was planned, as well as specific PSM models comparing individual IS medications associated with mortality. Results Out of 16,647 patients, 868 (5.2%) were on chronic IS therapy prior to admission and were considered ISP. In the PSM model, ISP had greater in-hospital mortality (OR 1.25, 95%CI 0.99-1.62), which was related to a worse outcome associated with chronic corticoids (OR 1.89, 95%CI 1.43-2.49). Other IS drugs had no repercussion on mortality risk (including calcineurin inhibitors (CNI), OR 1.19, 95% CI 0.65-2.20). In the pre-planned specific PSM model within patients on chronic IS treatment before admission, corticosteroids were associated with an increased risk of mortality (OR 2.34, 95%CI 1.43-3.82). Conclusions Chronic IS therapies pose a heterogeneous group of drugs with different risk profiles for severe COVID-19 and death. Chronic systemic corticosteroid is associated with increased mortality. On the contrary, CNI and other IS treatments prior to admission do not seem to convey different outcomes.

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Section: Discussionmentioning

confidence: 99%

Influence of chronic use of corticosteroids and calcineurin inhibitors on COVID-19 clinical outcomes: analysis of a nationwide registry

Calderón-Parra

Cuervas-Mons

Moreno-Torres

et al. 2022

International Journal of Infectious Diseases

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“…Studies from Italy and the Netherlands have similarly shown that comorbidity burden is an independent predictor of adverse COVID-19 outcomes among people with IBD ( 40 , 41 ). Notably, despite having exaggerated auto-inflammatory responses, persons with IBD do not appear to have an overall increased risk of developing severe COVID-19 than the general population ( 38 , 42–44 ). However, a study from Northern California did suggest that persons with IBD older than 66 years were more likely to acquire SARS-CoV-2 infection than younger persons with IBD ( 45 ).…”

Section: Covid-19 and The Elderly With Ibdmentioning

confidence: 98%

Crohn’s and Colitis Canada’s 2021 Impact of COVID-19 and Inflammatory Bowel Disease in Canada: Seniors With IBD

Bernstein

Singh

Murthy

et al. 2021

Journal of the Canadian Association of Gastroenterology

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The risk of hospitalization and death from Coronavirus disease-19 (COVID-19) increases with age. The extreme elderly have been particularly vulnerable, with those above the age of 80 having a case-fatality rate as high as 15%. Aging of the immune system can lead to impaired inflammatory responses where eradication of an organism such as Severe Acute Respiratory Syndrome CoronaVirus 2 (SARS-CoV2) is inadequate but is exaggerated in such a way as to enhance pneumonia and acute respiratory distress syndrome. Frailty and comorbidity are both more common in the elderly, and these can enhance the morbidity and mortality from COVID-19. Studies from Northern California and Italy suggest that elderly persons with inflammatory bowel disease (IBD) were more likely to acquire SARS-CoV-2 infection than youths with IBD. While the specific impact of age-related comorbidity is less well established among people with IBD who acquire COVID-19, data from the Surveillance Epidemiology of Coronavirus Under Research Exclusion (SECURE-IBD) database reported that having two or more chronic illnesses was independently associated with developing severe COVID-19 among people with IBD. Despite having exaggerated auto-inflammatory responses, people with IBD do not appear to have an overall increased risk of developing severe COVID-19 than the general population. However, whether seniors with IBD do worse once they acquire COVID-19 compared with seniors without IBD is not known. The advent of telehealth care has posed an information technology challenge for many seniors with and without IBD. Most persons with IBD have expressed satisfaction with virtual IBD health care (phone or video-based visits). While the elderly may have less robust immune responses to vaccinations, learning from experiences with other vaccination programs, especially influenza, have shown that vaccinating seniors decreases both morbidity and mortality and, in turn, healthcare resources.

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“…Similarly, Ustekinumab (anti IL12/12) has very low systemic activity and this would make it safer in case of COVID-19 [ 90 ]. In particular, elderly patients with comorbidities and a high risk of infection could take Vedolizumab or Ustekinumab if they need biologic therapy [ 91 ].…”

Section: Drugs and Inflammatory Bowel Diseases: What Have We Learned?mentioning

confidence: 99%

Risk, Course, and Effect of SARS-CoV-2 Infection in Children and Adults with Chronic Inflammatory Bowel Diseases

et al. 2021

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Susceptibility and disease course of COVID-19 among patients with inflammatory bowel diseases (IBD) are unclear and epidemiological data on the topic are still limited. There is some concern that patients with immuno-mediated diseases such as IBD, which are frequently treated with immunosuppressive therapies, may have an increased risk of SARS-CoV-2 infection with its related serious adverse outcomes, including intensive care unit (ICU) admission and death. Corticosteroids, immunomodulators, and biologic drugs, which are commonly prescribed to these patients, have been associated with higher rates of severe viral and bacterial infections including influenza and pneumonia. It is not known whether these drugs can be so harmful as to justify their interruption during COVID-19 infection or if, on the contrary, patients with IBD can benefit from them. As shown by recent reports, it cannot be excluded that drugs that suppress the immune system can block the characteristic cytokine storm of severe forms of COVID-19 and consequently reduce mortality. Another cause for concern is the up-regulation of angiotensin converting enzyme-2 (ACE2) receptors that has been noticed in these patients, which could facilitate the entry and replication of SARS-CoV-2. The aim of this narrative review is to clarify the susceptibility of SARS-CoV-2 infection in patients with IBD, the clinical characteristics of patients who contract the infection, and the relationship between the severity of COVID-19 and immunosuppressive treatment.

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COVID-19 in patients with inflammatory bowel disease

Cited by 10 publications

References 49 publications

Influence of chronic use of corticosteroids and calcineurin inhibitors on COVID-19 clinical outcomes: analysis of a nationwide registry

Influence of chronic use of corticosteroids and calcineurin inhibitors on COVID-19 clinical outcomes: analysis of a nationwide registry

Crohn’s and Colitis Canada’s 2021 Impact of COVID-19 and Inflammatory Bowel Disease in Canada: Seniors With IBD

Risk, Course, and Effect of SARS-CoV-2 Infection in Children and Adults with Chronic Inflammatory Bowel Diseases

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