GI Physicians Urge COVID-19 Vaccines for All IBD Patients

Marcia Frellick

December 11, 2020

Editor's note: Find the latest COVID-19 news and guidance in Medscape's Coronavirus Resource Center.

Gastroenterologists at the Advances in Inflammatory Bowel Disease (AIBD) 2020 Annual Meeting said they will strongly advise their patients to take the COVID-19 vaccines as they become available.

Announcement that the first vaccine, Pfizer's, was recommended for emergency use authorization came in the middle of AIBD's Thursday evening COVID-19 session.

Miguel Regueiro, MD, chair of Gastroenterology & Hepatology at Cleveland Clinic in Ohio, said, "We're uniformly recommending this to all our patients."

Maria Abreu

"The [vaccines] leading the pack do not have any replicating virus and thus can be used in immunocompromised people," Maria Abreu, MD, director of the Crohn's & Colitis Center at the University of Miami Miller School of Medicine, told Medscape Medical News. "Although it is true that we don't know — and won't know for a while — whether the high levels of efficacy seen with the mRNA vaccines so far will be achieved in patients who are immunocompromised, there is every reason to believe that [the vaccine] will still be enough to protect them from complications of COVID-19."

The bottom line, she said, is that "it's much safer to get a vaccine than it is to take your chances of getting COVID-19."

avid Rubin

David T. Rubin, MD, chief of gastroenterology, hepatology, and nutrition at UChicago Medicine, said in a session earlier in the day, "Emerging information about the messenger RNA looks like it's going to be safe for our population, but of course we want to see more. Messenger RNA degrades within days of giving it, so it's not expected to linger or generate any other problems we can think of."

Abreu said there's no evidence that IBD patients are more susceptible to COVID-19 infection even though the entry molecules are expressed in the GI tract. "They are really not differentially expressed in IBD and, if anything, some of our more potent therapies reduce the expression of these molecules in the GI tract," she said.

Regarding how IBD medications affect outcomes if patients are infected with COVID-19, Abreu pointed out that corticosteroids seem to be associated with worse outcomes. "I would posit that it has to do with initially allowing there to be a lot of very rapid viral replication," she said.

And she also noted that any of the mainstay drugs for IBD — the anti-TNF therapies — are showing promise as treatments for COVID-19.

Updates From the IBD-COVID-19 Registry

Michael Kappelman, MD, MPH, from the University of North Carolina at Chapel Hill, said information from the Secure-IBD registry, which collects real-time global information on how COVID-19 affects IBD patients, suggests that these patients "may have a more severe course than the general population, but not by much."

He reported the registry had logged more than 3300 reported COVID-19 cases among IBD patients from 62 countries.

Registry outcomes through the end of November have found a mean age of reported cases of 40 years, and that 21% of patients were hospitalized with an average length of stay of 10.2 days, 4% required intensive care unit admission, and 2% died.

The majority of the deaths reported to Secure-IBD occurred in patients older than 60 years, Kappelman said, adding that the hospitalizations and death rates in IBD patients with no comorbidities were relatively low.

"My belief is that available data are actually more reassuring than alarming," he said.

Kappelman and other investigators found that combination therapy that includes thiopurines and thiopurine monotherapy are "associated with about a fourfold risk of the requirement for intensive care or mortality from COVID," compared with anti-TNF monotherapy.

In cases reported to Secure-IBD, about 25% of IBD patients with COVID-19 developed new GI symptoms, primarily diarrhea and abdominal pain, he said.

In his practice, Kappelman said, he minimizes use of steroids and has found that COVID-19 adds a reason to favor anti-TNF over 6-mercaptopurine (6-MP) plus azathioprine.

He also advises "a high alert for COVID-19 in patients with new GI symptoms."

Abreu has relationships with Boehringer Ingelheim, Cosmo Biopharma, Eli Lilly, Gilead, Janssen, Landos Biopharma, Prometheus Bioscience, Takeda, UCB Biopharma, Pfizer, and Prometheus Laboratories 

Rubin has served as a director, officer, partner, employee, adviser, consultant, or trustee for AbbVie; Abgenomics; Allergan, Inc.; Boehringer Ingelheim; Bristol-Myers Squibb; Celgene; Dizal Pharmaceuticals; GalenPharma/Atlantica; Genentech/Roche; Gilead Sciences; Ichnos Sciences; GlaxoSmithKline; Janssen; Eli Lilly and Company; Pfizer; Prometheus Laboratories; Reistone; Shire; Takeda Pharmaceutical Company; and Techlab, Inc. In addition, he has received research grants from AbbVie, Genentech/Roche, Janssen Pharmaceuticals, Prometheus Laboratories, Shire, and Takeda Pharmaceutical Company; and holds stock options in Abgenomics and Biomica.

Regueiro and Kappelman  have disclosed no relevant financial relationships.

Advances in Inflammatory Bowel Diseases (AIBD) 2020 Annual Meeting: Session 8. Presented December 11, 2020.

Marcia Frellick is a freelance journalist based in Chicago . She has previously written for the Chicago Tribune, Science News and and was an editor at the Chicago Sun-Times, the Cincinnati Enquirer, and the St. Cloud ( Minnesota ) Times. Follow her on Twitter at @mfrellick

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