COVID-19 is not associated with worse long-term inflammatory bowel disease outcomes: a multicenter case–control study

Abstract

Background: Inflammatory bowel disease (IBD) is not associated with worse coronavirus disease 2019 (COVID-19) outcomes. However, data are lacking regarding the long-term impact of severe acute respiratory syndrome coronavirus 2 infection on the disease course of IBD. Objectives: We aimed to investigate the effect of COVID-19 on long-term outcomes of IBD. Design: We performed a multicenter case–control study of patients with IBD and COVID-19 between February 2020 and December 2020. Methods: Cases and controls were individuals with IBD with presence or absence, respectively, of COVID-19-related symptoms and confirmatory testing. The primary composite outcome was IBD-related hospitalization or surgery. Results: We identified 251 cases [ulcerative colitis ( n = 111, 45%), Crohn’s disease ( n = 139, 55%)] and 251 controls, with a median follow-up of 394 days. The primary composite outcome of IBD-related hospitalization or surgery occurred in 29 (12%) cases versus 38 (15%) controls ( p = 0.24) and on multivariate Cox regression, COVID-19 was not associated with increased risk of adverse IBD outcomes [adjusted hazard ratio (aHR): 0.84, 95% confidence interval [CI]: 0.44–1.42]. When stratified by infection severity, severe COVID-19 was associated with a numerically increased risk of adverse IBD outcomes (aHR: 2.43, 95% CI: 1.00–5.86), whereas mild-to-moderate COVID-19 was not (aHR: 0.68, 95% CI: 0.38–1.23). Conclusion: In this case–control study, COVID-19 did not have a long-term impact on the disease course of IBD. However, severe COVID-19 was numerically associated with worse IBD outcomes, underscoring the continued importance of risk mitigation and prevention strategies for patients with IBD during the ongoing COVID-19 pandemic.

Update des Addendums zu den S3-Leitlinien Morbus Crohn und Colitis ulcerosa: Betreuung von Patienten mit chronisch-entzündlichen Darmerkrankungen in Bezug auf COVID-19 (Version 2.0)

“…Risikofaktoren für einen schweren Erkrankungsverlauf Eine kürzlich publizierte große britische Studie weist auf der Basis von Behandlungsdaten bei CED-Patienten (n = 199 037) gegenüber der Vergleichsbevölkerung (n = 16 508 627) ein erhöhtes Risiko für eine stationäre Aufnahme (HR 1,25; CI 1,19-1,32) sowie ein gering erhöhtes Risiko für die Notwendigkeit einer ITS-Aufnahme oder Tod (HR 1,08, CI 1,01-1,16) [22] aus. Risikofaktoren für einen schweren Verlauf der Erkrankung (Hospitalisierung, intensivmedizinische Therapie, Mortalität) stellen ein erhöhtes Alter, eine zunehmende Anzahl von Komorbiditäten, eine erhöhte CED-Aktivität und der Gebrauch von Steroiden dar [6,12,15,16,19,[23][24][25][26][27]. Auch im SECURE-IBD-Register konnten genau diese Risikofaktoren bestätigt werden.…”

Managing IBD in the COVID-19 era

“…IBD associated hospitalization or surgery) (aHR 2.43, 95% CI 1.00–5.86) whereas severe COVID-19 did show an increased risk (aHR 0.84, 95% CI 0.44–1.42). 86 Whether COVID-19 infection alone can trigger an IBD flare remains unclear; current data suggests infection severity is likely the driving factor. Larger studies are needed to provide clarity.…”