IBD Patients With COVID-19 Not at Increased Risk of Severe Disease

By Anne Harding

June 17, 2020

NEW YORK (Reuters Health) - Patients with inflammatory bowel disease (IBD) who contract COVID-19 are not at increased risk of severe disease compared to people without IBD, new findings suggest.

While biologics and non-steroid immunomodulatory therapies were also not associated with worse COVID-19 outcomes in IBD patients, those who had received corticosteroids in the past three months were at greater risk of severe disease, Dr. Shailendra Singh of Charleston Gastroenterology in Charleston, West Virginia, and colleagues found.

"It is possible that corticosteroid use in IBD patients can reflect poorly controlled IBD and may as well represent poor access to IBD medication, healthcare, etc," Dr. Singh told Reuters Health by email. "We were not able to control for these factors in the retrospective analysis and further large studies are needed."

Dr. Singh and his colleagues used a federated health research network dataset, TriNetX, to identify more than 196,000 IBD patients from 31 healthcare organizations (HCOs), including 1,901 who were tested for COVID-19 between January 20 and May 26.

The team compared the risk of severe illness in the 232 IBD patients who tested positive with that in more than 19,000 patients without IBD diagnosed with COVID-19 during the same period. Severe illness, defined as hospitalization and/or 30-day mortality after COVID-19 diagnosis, occurred in 24% of the IBD patients and 21% of the non-IBD group.

The IBD patients were more likely to present with gastrointestinal symptoms, including nausea and vomiting (11% vs. 4%), diarrhea (8% vs. 5%) and abdominal pain (8% vs. 3%), they report in in Gastroenterology.

Unadjusted analysis found a similar risk of severe COVID-19 for patients with and without IBD (relative risk, 1.15; P=0.23), and this did not change after propensity-score matching (RR, 0.93; P=0.66).

The IBD patients with severe illness were older and had more comorbidities than those who did not become severely ill.

Medication data was available for 166 IBD patients, including 62 who were on biologics and/or immunomodulators, 32 on aminosalicylate drugs and 111 prescribed corticosteroids. Use of immune-mediated treatments in the year before COVID-19 diagnosis did not confer an increased risk of severe illness (RR, 1.01; P=0.97).

Among 71 patients who had received corticosteroids in the past three months, 31% developed severe illness, versus 19% of those with no recent corticosteroid use (RR, 1.60; P=0.04).

"IBD patients in remission and on immunomodulators and biologics should stay on their medications," Dr. Singh said.

"The risk for severe COVID-19 in IBD patients is also similar to the widely recognized risk factors for COVID-19 outcomes, such as advanced age and comorbidities such as diabetes, chronic lung disease, heart disease, and such patients should be closely monitored and aggressively managed," he added.

"Larger multicenter studies are definitely needed to understand the role of biologics, immunomodulatory medications, and steroid use in IBD patients with COVID-19," Dr. Singh concluded.

The study had no funding. One of Dr. Singh's coauthors report ties to drug makers.

SOURCE: https://bit.ly/2UOljId Gastroenterology, online June 6, 2020.