Uneventful Course in Patients With Inflammatory Bowel Disease During the Severe Acute Respiratory Syndrome Coronavirus 2 Outbreak in Northern Italy

Norsa, Lorenzo; Indriolo, A.; Sansotta, Naire; Cosimo, Paola; Greco, Salvatore; D’Antiga, Lorenzo

doi:10.1053/j.gastro.2020.03.062

Cited by 134 publications

(105 citation statements)

References 7 publications

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“…3 In an Italian observational study, among 522 IBD patients (89% adults), 16% under biological therapy, none was hospitalized for COVID-19. 4 We confirm this observation.…”

Section: To the Editorssupporting

confidence: 81%

Inflammatory Bowel Diseases and Biological Treatment in SARS-CoV-2 Era. Why Not?

Grassia

Soro

Conti

2020

Inflammatory Bowel Diseases

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“…3 In an Italian observational study, among 522 IBD patients (89% adults), 16% under biological therapy, none was hospitalized for COVID-19. 4 We confirm this observation.…”

Section: To the Editorssupporting

confidence: 81%

Inflammatory Bowel Diseases and Biological Treatment in SARS-CoV-2 Era. Why Not?

Grassia

Soro

Conti

2020

Inflammatory Bowel Diseases

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“…6 The second study reported that among 522 IBD patients followed in a tertiary centre at Bergamo, the province with the highest rate of infection worldwide, no case of COVID-19 was diagnosed. 7 The third study reported a single case of COVID-19 occurring in an adult patient with UC. 9 The fourth study reported eight children with IBD who had mild SARS- Regarding outcomes, the high case fatality rate in our cohort was not significantly different from that of the general population in the region.…”

Section: Discussionmentioning

confidence: 99%

2019 novel coronavirus disease (COVID‐19) in patients with inflammatory bowel diseases

Taxonera

Sagastagoitia

Alba

et al. 2020

Aliment Pharmacol Ther

162

188

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Background: Data on patients with inflammatory bowel diseases (IBD) who have had 2019 novel coronavirus (SARS-CoV-2) disease (COVID-19) are needed.Aim: To report the clinical characteristics, including gastrointestinal symptoms, of COVID-19 in IBD patients, and to assess the risk of COVID-19 in IBD. Methods:This case series included consecutive IBD patients with laboratory-confirmed COVID-19. Age-adjusted cumulative incidences were compared with the general population in the Madrid region.Results: Through April 8, 12 of 1918 IBD patients were diagnosed with COVID-19. The average age was 52 years, 75% of the patients were female and 58.3% had Crohn's disease. Seven patients (58%) were on maintenance treatment with immunomodulators/biologics, of these four with combined therapy (33%). Eight patients (66%) required hospitalisation (one intensive care unit admission, and two deaths), and four patients were isolated at home. Nine patients had diarrhoea ranging between 4 and 10 loose stools per day (mean 5.4, SD 1.6). In five patients (42%) diarrhoea was a presenting symptom. In two patients, diarrhoea was the only symptom at debut. Cumulative incidence of COVID-19 was 6.2 per 1000 IBD patients. IBD patients had a lower adjusted incidence ratio of COVID-19 (OR 0.74, 95% CI 0.70-0.77; P < 0.001), and a similar associated mortality ratio (OR 0.95, 95% CI: 0.84-1.06; P = 0.36), compared with the general population.Conclusions: IBD patients do not have an increased risk of COVID-19 and associated mortality compared with the general population. In many IBD patients, diarrhoea was a presenting symptom, and sometimes, was the only symptom at onset of COVID-19. IMM treatment, n (%) 559 (29.1) Azathioprine, n (%) 353 (63.1) Mercaptopurine, n (%) 105 (18.8) Methotrexate, n (%) 90 (16.1) Tofacitinib*, n (%) 6 (1.1) Tacrolimus, n (%) 2 (0.3) Mycophenolate, n (%) 3 (0.5) Biological treatment, n (%) 301 (15.7) Infliximab, n (%) 110 (36.5) Adalimumab, n (%) 119 (39.5) Golimumab, n (%) 31 (10.3) Vedolizumab, n (%) 18 (6.0) Ustekinumab, n (%) 23 (7.6) Biological + IMM treatment, n (%) 157 (8.2) IMM alone, n (%) 402 (20.9) Biologics alone n (%) 144 (7.5) Disease location (L): L1 terminal ileum, L2 colon, L3 ileocolon, L4 upper gastrointestinal tract; Disease behaviour (B): B1 nonstricturing nonpenetrating; B2 stricturing, B3 penetrating. IMM: immunomodulator; Tofacitinib* is a JAKinase inhibitor not similar to conventional IMM. Abbreviations: IQR, interquartile range; Montreal classification' of Crohn's disease (CD); SD, standard deviation; UC, ulcerative colitis.

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“…The relatively few patients, however, is in line with a report from Bergamo Hospital, where there were no cases of COVID-19 among patients with IBD, and no hospitalisations, in one of the most affected areas of northern Italy. 10 Second, the diagnosis and tallying of COVID-19 cases in Italy differ from region to region, and may be underestimated or overestimated depending on the geographical provenience. We identified our patients with COVID-19 based on criteria of the Italian Ministry of Health, 23 but some patients may remain undiagnosed.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of COVID-19 in 79 patients with IBD in Italy: an IG-IBD study

Bezzio¹,

Saibeni²,

Variola

et al. 2020

Gut

294

366

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ObjectivesCOVID-19 has rapidly become a major health emergency worldwide. Patients with IBD are at increased risk of infection, especially when they have active disease and are taking immunosuppressive therapy. The characteristics and outcomes of COVID-19 in patients with IBD remain unclear.DesignThis Italian prospective observational cohort study enrolled consecutive patients with an established IBD diagnosis and confirmed COVID-19. Data regarding age, sex, IBD (type, treatments and clinical activity), other comorbidities (Charlson Comorbidity Index (CCI)), signs and symptoms of COVID-19 and therapies were compared with COVID-19 outcomes (pneumonia, hospitalisation, respiratory therapy and death).ResultsBetween 11 and 29 March 2020, 79 patients with IBD with COVID-19 were enrolled at 24 IBD referral units. Thirty-six patients had COVID-19-related pneumonia (46%), 22 (28%) were hospitalised, 7 (9%) required non-mechanical ventilation, 9 (11%) required continuous positive airway pressure therapy, 2 (3%) had endotracheal intubation and 6 (8%) died. Four patients (6%) were diagnosed with COVID-19 while they were being hospitalised for a severe flare of IBD. Age over 65 years (p=0.03), UC diagnosis (p=0.03), IBD activity (p=0.003) and a CCI score >1 (p=0.04) were significantly associated with COVID-19 pneumonia, whereas concomitant IBD treatments were not. Age over 65 years (p=0.002), active IBD (p=0.02) and higher CCI score were significantly associated with COVID-19-related death.ConclusionsActive IBD, old age and comorbidities were associated with a negative COVID-19 outcome, whereas IBD treatments were not. Preventing acute IBD flares may avoid fatal COVID-19 in patients with IBD. Further research is needed.

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Uneventful Course in Patients With Inflammatory Bowel Disease During the Severe Acute Respiratory Syndrome Coronavirus 2 Outbreak in Northern Italy

Cited by 134 publications

References 7 publications

Inflammatory Bowel Diseases and Biological Treatment in SARS-CoV-2 Era. Why Not?

Inflammatory Bowel Diseases and Biological Treatment in SARS-CoV-2 Era. Why Not?

2019 novel coronavirus disease (COVID‐19) in patients with inflammatory bowel diseases

Outcomes of COVID-19 in 79 patients with IBD in Italy: an IG-IBD study

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