Coronavirus Disease 2019

Update on Coronavirus Disease 2019 Outcomes and Vaccine Efficacy in Patients With Immune-Mediated Inflammatory Disease

Jeffrey A. Sparks; Zachary S. Wallace; Philip C. Robinson


Curr Opin Rheumatol. 2021;33(5):412-418. 

In This Article


In contrast to rheumatic diseases, inflammatory bowel diseases (IBD), such as Crohn's disease and ulcerative colitis have relatively less heterogeneity. A recent large nationwide population-based matched retrospective study in Sweden showed that IBD patients were significantly more likely to be hospitalized for COVID-19 than matched comparators.[38] Another nationwide Danish study identified IBD patients with COVID-19 and compared with a population-based cohort.[39] This study found that IBD patients had lower prevalence of COVID-19 than the general population, offering reassurance but was limited by small numbers of IBD patients.[39] In a meta-analysis of 24 studies, SARS-CoV-2 infection risk in patients with IBD was similar to the general population.[40] COVID-19 outcomes for IBD patients were worse in ulcerative colitis compared with Crohn's disease.

Gastroenterologists formed a physician registry called Surveillance Epidemiology of Coronavirus Under Research Exclusion for IBD (SECURE-IBD) early in the pandemic, which was a model that the GRA adapted. The initial report in SECURE-IBD reported higher odds of hospitalization for COVID-19 in patients on baseline glucocorticoids and lower odds for IBD patients on TNFi.[9] A larger follow-up study reported that thiopurine monotherapy or in combination was strongly associated with severe COVID-19 outcomes compared with TNFi monotherapy.[8] This offered further reassurance to the safety of biologic DMARDs, such as TNFi as this finding has been observed across several diseases and organ systems.[31] It is not currently clear whether these findings are because of a possible protective effect of TNFi or whether the findings may be confounded. Trials are underway to investigate possible efficacy of TNFi for treating COVID-19.[41,42] Another large study identified all people with IBD in the Veterans Affairs Healthcare System and found that vedolizumab and glucocorticoids were associated with severe COVID-19 outcomes.[43]

Overall, the experience of IBD during the COVID-19 has mostly offered reassurance that patients have at best modestly increased risk for severe outcomes compared with the general population. The outcomes of those on TNFi also provides reassurance that this class of medication may be safely continued. Conversely, other medications used in IBD, such as glucocorticoids, thiopurines, and vedolizumab may be associated with more severe COVID-19 outcomes.