The Course of SARS-COV2 Infection Was Not Severe in a Crohn’s Patient Who Administered Maintenance Anti-TNF Therapy Overlapping the Early Pre-Symptomatic Period of Infection

Abstract

The Inflammatory Bowel Disease (IBD) population, which may require treatment with immunosuppressive medications, may be uniquely vulnerable to COVID-19 infection. In fact, there is some evidence these medications may inhibit the cytokine storm that is theorized to cause a rapid decline seen in COVID-19. In addition, the digestive symptoms of COVID-19 can be difficult to distinguish from the activation of IBD. We present an interesting case of a Crohn’s patient inadvertently administering anti-cytokine therapy during the pre-symptomatic period of COVID-19 infection. Immune suppression during early infection with SARS-COV2 risks a poor immune response to the virus and could theoretically result in a more severe course of infection.

Systematic review with meta‐analysis: COVID‐19 outcomes in patients receiving anti‐TNF treatments

“…Our systematic search of the literature allowed us to identify 37 case reports and case series 20‐56 and 11 studies that corresponded to our research question but their data were provided descriptively and an effect measure could not be calculated 21,57‐66 . These data are included in Table S1.…”

Granulocyte and monocyte apheresis therapy for patients with active ulcerative colitis associated with COVID-19: a case report

“…18 In other words, remission induction therapy with biologics such as TNF-α antibody drugs for flares of UC complicated by severe COVID-19 may lead to the remission of the UC without exacerbating the pathogenesis of COVID-19, but this is still not fully understood. 19 In addition, it has been suggested that the removal of activated myeloid cells by GMA may improve not only the pathogenesis of UC but also the pathogenesis of COVID-19 without the need for immunosuppression therapy. 20 GMA therapy may thus provide a positive outcome for flares of UC complicated by COVID-19, both in the induction of UC remission and the control of COVID-19.…”

“…Coronavirus disease 2019 (COVID- 19), caused by infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has become a worldwide pandemic within a short period of time. 1 Patients with inflammatory bowel disease (IBD) have a risk of contracting SARS-CoV-2 that is similar to the risk among the general population; however, steroids used in the treatment of IBD increase the risk of SARS-CoV-2 infection.…”

Favorable outcome of COVID-19 in a young woman with severe Crohn’s disease on regular use of adalimumab and prednisone: a case report

“…The medical literature has already shown some adalimumab users that presented with uncomplicated forms of COVID-19 17 - 19 . Narcisi et al 17 have described a case of a 57-year-old male patient with a 9- year history of psoriasis and psoriatic arthritis treated with adalimumab every 2 weeks for almost two years before the onset of COVID-19 symptoms and the development of lung pneumonia with no need of oxygen support.…”

“…Swaminath et al . 19 reported a case of a 60-year-old female nurse with a past medical history of autoimmune disease, including rheumatoid arthritis (RA), systemic lupus erythematosus (SLE) and ileocolonic inflammatory Crohn’s disease in endoscopic remission. Both, the joint and bowel complaints, have been controlled for many years on weekly adalimumab and methotrexate.…”