The natural history of COVID-19 in patients with inflammatory bowel disease: a nationwide study by the Hellenic Society for the study of IBD

Bamias, Giorgos; Kokkotis, Georgios; Christidou, Angeliki; Christodoulou, Dimitrios; Delis, Vasileios; Διαμαντοπούλου, Γεωργία; Fessatou, Smaragdi; Gatopoulou, Anthia; Γιουλεμέ, Όλγα; Kafritsa, Panagiota; Kalantzis, Chrisostomos; Kapsoritakis, Andreas; Karmiris, Konstantinos; Κατσάνος, Κωνσταντίνος; Kevrekidou, P; Kosmidis, Charalampos; Mantaka, Aikaterini; Mathou, Nicoletta; Michalopoulos, George; Michopoulos, Spyridon; Papaconstantinou, Ioannis; Papatheodoridis, George; Polymeros, Dimitrios; Potamianos, Spyros; Poulopoulos, Georgios; Protopapas, Andreas; Sklavaina, Maria; Soufleris, Konstantinos; Theocharis, Georgios; Theodoropoulou, Anǵeliki; Triantafillidis, John K.; Triantafyllou, Konstantinos; Tsiolakidou, Georgia; Tsironi, Eftychia; Tzouvala, Maria; Viazis, Nikos; Xourgias, V; Zacharopoulou, Eirini; Zampeli, Evanthia; Mantzaris, Gerasimos

doi:10.1097/meg.0000000000002267

Cited by 7 publications

(9 citation statements)

References 32 publications

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“…The later can be partly explained by the fact that such agents (anti-TNFα) reduce the cytokine activation taking place after the inflammatory response to vaccination and therefore patients experience less AEs [3]. In fact, this somehow-protective anti-TNF effect has also been validated even in COVID-19 infection cases [27]. Whether this decrease in adverse event rates might reflect a reduced serologic response to vaccination is yet to be defined, but recently observed data do indicate an impaired antibody production after vaccination against COVID-19 in anti-TNFα recipients [9,28,29].…”

Section: Discussionmentioning

confidence: 99%

Real-World Use and Adverse Events of SARS-CoV-2 Vaccination in Greek Patients with Inflammatory Bowel Disease

Orfanoudaki

Zacharopoulou

Kitsou

et al. 2022

JCM

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Since inflammatory bowel disease (IBD) patients were excluded from vaccine authorization studies, limited knowledge exists regarding perceptions and unfavorable effects of COVID-19 vaccination in this group. We aimed to investigate the real-world use and adverse events (AEs) of COVID-19 vaccines in Greek IBD patients. Fully vaccinated IBD patients followed in Greek centers were invited to participate. All patients filled out an anonymous online survey concerning the vaccination program, which included information regarding demographics, clinical characteristics, treatment, vaccination perceptions and potential AEs. Overall, 1007 IBD patients were included. Vaccine hesitancy was reported by 49%. Total AEs to vaccination were reported by 81% after dose 1 (D1) and 76% after dose 2 (D2), including isolated injection site reactions (36% and 24% respectively). Systemic AEs were more common after D2 (51%, D2 vs. 44%, D1, p < 0.0001). Very few patients reported new onset abdominal symptoms (abdominal pain 4% (D1), 6% (D2) and diarrhea 5% (D1), 7% (D2)). There were no serious AEs leading to emergency room visit or hospitalization. In multivariate analysis, AEs occurrence was positively associated with young age and female gender (p < 0.0005 for both doses), whereas inactive disease was negatively associated with AE in D1 (p = 0.044). SARS-CoV-2 vaccination in Greek IBD patients demonstrated a favorable and reassuring safety profile.

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Section: Discussionmentioning

confidence: 99%

Real-World Use and Adverse Events of SARS-CoV-2 Vaccination in Greek Patients with Inflammatory Bowel Disease

Orfanoudaki

Zacharopoulou

Kitsou

et al. 2022

JCM

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“…Initial data suggested that the case fatality rate for patients with IBD could be high, ranging from 0% to 33.3% 20 22 41–45. As more nuanced data became available, the rate was considerably much lower; in one meta-analysis, pooled mortality rate was 4.3% in patients with IBD with COVID-19, which was similar to that of the general population 30.…”

Section: Impact Of Ibd On Covid-19mentioning

confidence: 96%

“…In these studies, however, clinical course in hospitalised patients was similar to those not hospitalised, reflecting intercountry variation in threshold for hospital admission. Data for patients with IBD, obtained later in the pandemic, were estimated to range from 21% in European to 66% in Latin American regions 22 42–45. In 1 meta-analysis of 11 studies across the world, the pooled hospitalisation rate due to COVID-19 was 28% 30.…”

Section: Impact Of Ibd On Covid-19mentioning

confidence: 99%

“…Risk factors associated with adverse clinical outcomes, including ICU admission, mechanical ventilation and/or death are advanced age, dyspnoea on presentation, active IBD, presence of ≥1 comorbidity and the use of systemic steroids 24 25 34 42–45 47 51. One validated prognostic model used to predict adverse outcomes in patients with IBD with COVID-19, following adjustment for known risk factors including age, male gender, comorbidity, corticosteroid and biological use, demonstrated an excellent discrimination with an area under curve of 0.79 for hospitalisation, 0.88 for ICU admission and 0.94 for death 50…”

Section: Impact Of Ibd On Covid-19mentioning

confidence: 99%

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Recent advances in clinical practice: management of inflammatory bowel disease during the COVID-19 pandemic

Lin

Lau

Chanchlani

et al. 2022

Gut

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The COVID-19 pandemic has raised considerable concerns that patients with inflammatory bowel disease (IBD), particularly those treated with immunosuppressive therapies, may have an increased risk of SARS-CoV-2 acquisition, develop worse outcomes following COVID-19, and have suboptimal vaccine response compared with the general population. In this review, we summarise data on the risk of COVID-19 and associated outcomes, and latest guidance on SARS-CoV-2 vaccines in patients with IBD. Emerging evidence suggests that commonly used medications for IBD, such as corticosteroids but not biologicals, were associated with adverse outcomes to COVID-19. There has been no increased risk of de novo, or delayed, IBD diagnoses, however, an overall decrease in endoscopy procedures has led to a rise in the number of missed endoscopic-detected cancers during the pandemic. The impact of IBD medication on vaccine response has been a research priority recently. Data suggest that patients with IBD treated with antitumour necrosis factor (TNF) medications had attenuated humoral responses to SARS-CoV-2 vaccines, and more rapid antibody decay, compared with non-anti-TNF-treated patients. Reassuringly, rates of breakthrough infections and hospitalisations in all patients who received vaccines, irrespective of IBD treatment, remained low. International guidelines recommend that all patients with IBD treated with immunosuppressive therapies should receive, at any point during their treatment cycle, three primary doses of SARS-CoV-2 vaccines with a further booster dose as soon as possible. Future research should focus on our understanding of the rate of antibody decay in biological-treated patients, which patients require additional doses of SARS-CoV-2 vaccine, the long-term risks of COVID-19 on IBD disease course and activity, and the potential risk of long COVID-19 in patients with IBD.

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“…However, it seems that these patients do not carry an increased risk for serious COVID-19 disease [ 17 , 18 ]. On the contrary, anti-TNF-α use was associated with reduced risk for hospitalization in SARS-CoV-2-infected patients with rheumatic diseases [ 98 , 99 ], psoriasis [ 100 ] and IBD [ 101 ].…”

Section: Introductionmentioning

confidence: 99%

The second decade of anti-TNF-a therapy in clinical practice: new lessons and future directions in the COVID-19 era

et al. 2022

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Since the late 1990s, tumor necrosis factor alpha (TNF-α) inhibitors (anti-TNFs) have revolutionized the therapy of immune-mediated inflammatory diseases (IMIDs) affecting the gut, joints, skin and eyes. Although the therapeutic armamentarium in IMIDs is being constantly expanded, anti-TNFs remain the cornerstone of their treatment. During the second decade of their application in clinical practice, a large body of additional knowledge has accumulated regarding various aspects of anti-TNF-α therapy, whereas new indications have been added. Recent experimental studies have shown that anti-TNFs exert their beneficial effects not only by restoring aberrant TNF-mediated immune mechanisms, but also by de-activating pathogenic fibroblast-like mesenchymal cells. Real-world data on millions of patients further confirmed the remarkable efficacy of anti-TNFs. It is now clear that anti-TNFs alter the physical course of inflammatory arthritis and inflammatory bowel disease, leading to inhibition of local and systemic bone loss and to a decline in the number of surgeries for disease-related complications, while anti-TNFs improve morbidity and mortality, acting beneficially also on cardiovascular comorbidities. On the other hand, no new safety signals emerged, whereas anti-TNF-α safety in pregnancy and amid the COVID-19 pandemic was confirmed. The use of biosimilars was associated with cost reductions making anti-TNFs more widely available. Moreover, the current implementation of the “treat-to-target” approach and treatment de-escalation strategies of IMIDs were based on anti-TNFs. An intensive search to discover biomarkers to optimize response to anti-TNF-α treatment is currently ongoing. Finally, selective targeting of TNF-α receptors, new forms of anti-TNFs and combinations with other agents, are being tested in clinical trials and will probably expand the spectrum of TNF-α inhibition as a therapeutic strategy for IMIDs.

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The natural history of COVID-19 in patients with inflammatory bowel disease: a nationwide study by the Hellenic Society for the study of IBD

Abstract: Supplemental Digital Content is available in the text.

Cited by 7 publications

References 32 publications

Real-World Use and Adverse Events of SARS-CoV-2 Vaccination in Greek Patients with Inflammatory Bowel Disease

Real-World Use and Adverse Events of SARS-CoV-2 Vaccination in Greek Patients with Inflammatory Bowel Disease

Recent advances in clinical practice: management of inflammatory bowel disease during the COVID-19 pandemic

The second decade of anti-TNF-a therapy in clinical practice: new lessons and future directions in the COVID-19 era

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