Epidemiology and the Impact of Therapies on the Outcome of COVID-19 in Patients With Inflammatory Bowel Disease

Papa, Alfredo; Gasbarrini, Antonio; Tursi, Antonio

doi:10.14309/ajg.0000000000000830

Cited by 23 publications

(19 citation statements)

References 13 publications

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“…Emerging studies are indicating a beneficial association between immunosuppressive therapies and COVID-19 outcomes, among both patients with IBD and patients with other IMIDs. 26 , 27 Although such an association remains to be demonstrated in larger cohorts, we hypothesise that the inflammatory pathways of COVID-19 and those of IBD and other IMIDs are not overlapping.…”

Section: Discussionmentioning

confidence: 84%

Prevalence and Outcomes of COVID-19 Among Patients With Inflammatory Bowel Disease—A Danish Prospective Population-based Cohort Study

Attauabi

Poulsen

Theede

et al. 2020

Journal of Crohn's and Colitis

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Background and Aims As no population-based study has investigated the susceptibility and disease course of COVID-19 among patients with inflammatory bowel diseases (IBD), we aimed to investigate this topic in a population-based setting. Methods Two cohorts were investigated. First, a nationwide cohort of all IBD patients diagnosed with COVID-19 was prospectively followed to investigate the disease courses of both diseases. Second, within a population-based cohort of 2.6 million Danish citizens, we identified all individuals tested for SARS-CoV-2 to determine the occurrence of COVID-19 among patients with and without IBD and other immune-mediated inflammatory diseases (IMIDs). Results Between January 28, 2020 and June 2, 2020, a total of 76 IBD patients with COVID-19 were identified in the national cohort and prospectively followed for 35 days (interquartile range (IQR): 25-51). A large proportion (n=19;25%) required a COVID-19-related hospitalization for seven days (IQR: 2-8.5) which was associated with being 65 years or older (odds ratio (OR)=23.80 (95% confidence interval (CI) 6.32-89.63), p<0.01) and presence of any non-IMID comorbidity (OR=8.12 (95% CI 2.55-25.87), p<0.01), but not use of immunomodulators (p=0.52) or biologic therapies (p=0.14). In the population-based study, 8,476 of 231,601 (3.7%) residents tested positive for SARS-CoV-2; however, the occurrence was significantly lower among patients with IBD (62 of the 2,486 patients=2.5%, p<0.01) and other IMIDs (531 of 16,492 patients=3.2%, p<0.01) as compared to patients without IMIDs. Conclusion Patients with IMIDs, including IBD, had a significantly lower susceptibility to COVID-19 than patients without IMIDs and neither immunosuppressive therapies nor IBD activity were associated with the disease course of COVID-19.

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Section: Discussionmentioning

confidence: 84%

Prevalence and Outcomes of COVID-19 Among Patients With Inflammatory Bowel Disease—A Danish Prospective Population-based Cohort Study

Attauabi

Poulsen

Theede

et al. 2020

Journal of Crohn's and Colitis

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“…Since the worst forms of COVID-19 develop as the result of an uncontrolled and overactive immune response against the virus [29], the immunosuppressed state due to biological therapy may actually protect patients from it [30]. Indeed, therapies with anti-TNF were associated with better outcomes of COVID-19 in IBD patients who contracted SARS-CoV-2 infection [31] and active phases of IBD are associated with a more severe course of COVID-19 [32]. A large multicentre study in patients with rheumatic diseases confirmed these findings, since anti-TNF therapies were associated with decreased odds of hospitalisation for COVID-19, while neither the exposure to conventional disease-modifying antirheumatic drugs nor non-steroidal anti-inflammatory drugs were associated with increased odds of hospitalisation [33].…”

Section: Discussionmentioning

confidence: 99%

Hospitalisation for Drug Infusion Did Not Increase Levels of Anxiety and the Risk of Disease Relapse in Patients with Inflammatory Bowel Disease during COVID-19 Outbreak

Bertani

Barberio

Tricò

et al. 2021

JCM

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During the coronavirus disease 2019 (COVID-19) pandemic, immunomodulatory therapies and hospital admission were suspected to increase the risk of infection. Nevertheless, patients with inflammatory bowel diseases (IBD) treated with intravenous (i.v.) biologics had to move to hospitals for drug infusion. We investigated the impact of hospitalisation in patients with IBD. We conducted a survey including consecutive IBD patients initially in clinical and biochemical remission treated with biologics at the end of the first lockdown period. Patients underwent the normally scheduled clinical visits, performed at hospital for i.v.-treated patients or at home for patients treated with s.c. drugs. We administered to all patients the Hospital Anxiety and Depression Scale (HADS) questionnaire and other 12 questions, specifically related to COVID-19 and its implications. A total of 189 IBD patients were recruited, 112 (59.3%) treated with i.v. drugs and 77 (40.7%) with s.c. ones. No relapses were recorded in either group (hospitalized vs. non-hospitalized, p = ns), as well as which, COVID-19 infections were not demonstrated in patients in contact with people with suspected symptoms or directly experiencing them. The total HADS score obtained by the sum of all items was also almost identical between groups (37.1 ± 2.8 vs. 37.2 ± 2.8; p = 0.98). In patients treated with i.v. drugs receiving a televisit (n = 17), the rate of satisfaction with telemedicine (58.8%) was significantly lower compared with those treated with s.c. drugs (94.8%; p < 0.0005). Our results suggest that hospitalisation during the COVID-19 outbreak does not increase the risk of COVID-19 infection as well as the risk of IBD relapse; moreover, the similar levels of anxiety in both groups could confirm that there is no need to convert patients from i.v. to s.c. therapy.

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“… 22 Further support to this theory comes from the results of the Italian Group for the Study of Inflammatory Bowel Disease study, which reported 60% reduction in mortality among patients receiving anti-TNF-α antibodies (although not statistically significant); however, corticosteroid use was associated with a trend toward statistical significance, with COVID-19-related pneumonia ( p = 0.05) and death ( p = 0.064). 23 On the other hand, steroid use should be avoided, if possible, or rapid steroid tapering should be considered owing to the risk of respiratory or opportunistic infection that could complicate the course of COVID-19. Glucocorticoids presumably have various effects in the different phases of the cytokine storm; therefore, they can be recommended as an ultimate last resource if needed.…”

Section: Ibd and Viral Infections – Including Sars-cov-2 Virusmentioning

confidence: 99%

The complex relationship between viruses and inflammatory bowel disease – review and practical advices for the daily clinical decision-making during the SARS-CoV-2 pandemic

Farkas

Pigniczki

Rutka

et al. 2021

Therap Adv Gastroenterol

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The coronavirus disease 2019 (COVID-19) outbreak emerged in December 2019 in China and rapidly spread worldwide. Inflammatory bowel disease (IBD) patients are likely to be more susceptible to viral infections, and this is significantly influenced by the type of therapy they receive. Thus, issues specifically concerning the medical treatment of IBD patients were shortly addressed at the beginning of the pandemic. However, recently available data on the occurrence and outcome of SARS-CoV-2 infection in IBD patients does not address the concerns raised at the beginning of the pandemic. Growing evidence and the rapid changes happening over the past few weeks have helped elucidate the current situation, contribute to our understanding of the disease, and many previously raised questions could now be answered. We hereby summarise available evidence regarding viral infections and IBD, focusing on SARS-CoV infections, and we provide practical recommendations related to patient management during the COVID-19 pandemic era.

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Epidemiology and the Impact of Therapies on the Outcome of COVID-19 in Patients With Inflammatory Bowel Disease

Cited by 23 publications

References 13 publications

Prevalence and Outcomes of COVID-19 Among Patients With Inflammatory Bowel Disease—A Danish Prospective Population-based Cohort Study

Prevalence and Outcomes of COVID-19 Among Patients With Inflammatory Bowel Disease—A Danish Prospective Population-based Cohort Study

Hospitalisation for Drug Infusion Did Not Increase Levels of Anxiety and the Risk of Disease Relapse in Patients with Inflammatory Bowel Disease during COVID-19 Outbreak

The complex relationship between viruses and inflammatory bowel disease – review and practical advices for the daily clinical decision-making during the SARS-CoV-2 pandemic

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