Although COVID-19 has affected the management of patients with acute severe ulcerative colitis, a study found similar outcomes among these patients during the pandemic period compared with prior to the pandemic. These findings were reported in The Lancet Gastroenterology & Hepatology.

A group of investigators from the PROTECT-ASUC Study Group (ClinicalTrials.gov Identifier: NCT04411784) conducted a multicenter, observational, case-control study to assess the influence of the COVID-19 pandemic on established, conventional, evidence-based management of patients with acute severe ulcerative colitis and the effect on patient outcomes including COVID-19 acquisition as well as severity.

The primary outcome was the proportion of patients with acute severe ulcerative colitis who underwent rescue therapy (including primary induction) or colectomy. All participants were either admitted to or managed in emergency ambulatory care settings from March 1, 2020, to June 30, 2020 (the COVID-19 pandemic period cohort), or from January 1, 2019, to June 30, 2019 (the historical control cohort). All patients with either ulcerative colitis or unclassified inflammatory bowel disease who presented with acute severe ulcerative colitis according to the Truelove and Witts criteria were included in the study.


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A total of 782 adults (398 in the pandemic period cohort and 384 in the historical control cohort) from 60 acute secondary care hospitals throughout the United Kingdom were enrolled in the study.

The investigators found that the proportion of patients who underwent rescue therapy (including primary induction) or surgery was higher during the pandemic period compared with the historical period (217 [55%] of 393 patients vs 159 [42%] of 380 patients; P =.00024). In addition, the time to rescue therapy was shorter for the pandemic patients compared with the historical patients (P=.0026).

This difference was driven by a greater use of rescue as well as primary induction therapies with biologics, cyclosporine, or tofacitinib in the COVID-19 pandemic period cohort compared with the historical control period cohort (177 [46%] of 387 patients in the COVID-19 cohort vs 134 [36%] of 373 patients in the historical cohort; P=.0064).

During the pandemic, a larger proportion of patients received ambulatory (outpatient) intravenous steroids (51 [13%] of 385 patients vs 19 [5%] of 360 patients; P=.00023). A smaller proportion of patients received thiopurines (29 [7%] of 398 patients vs 46 [12%] of 384; P=.029) and 5-aminosalicylic acids (67 [17%] of 398 patients vs 98 [26%] of 384; P=.0037) during the pandemic compared with the historical control period.

Colectomy rates were found to be similar between the pandemic and historical control groups (64 [16%] of 389 vs 50 [13%] of 375; P=.26); however, laparoscopic surgery was performed less frequently during the pandemic period (34 [53%] of 64 vs 38 [76%] of 50; P=.018).

During hospital treatment, 5 (2%) of 253 patients tested positive for SARS-CoV-2. During the 3-month follow-up, 2 (2%) of 103 patients re-tested for SARS-CoV-2 were found to be positive (at day 5 for one and at day 12 for the second) following hospital discharge. No serious outcomes were reported. 

Limitations of this study include the retrospective nature of the study design and lack of data on the dose or duration of steroids administered. In addition, adverse events associated with rescue therapy, surgery, and postoperative may not have been captured.

These data indicated that the practice patterns of gastroenterologists and colorectal surgeons regarding the management of patients with acute severe ulcerative colitis were altered by the COVID-19 pandemic. Nevertheless, patients with acute severe ulcerative colitis had similar outcomes irrespective of period (during or prior to the pandemic). However, additional large cohort prospective studies assessing treatment of acute severe ulcerative colitis during the COVID-19 pandemic are warranted to elucidate any potential changes in patient outcomes.

“To our knowledge, we report one of the largest series of patients diagnosed with acute severe ulcerative colitis to date. This cohort will have relevance to the contemporary management of ulcerative colitis beyond the COVID-19 pandemic period,” the study authors wrote.

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.

Reference

Sebastian S, Walker GJ, Kennedy NA, et al; on behalf of the PROTECT-ASUC Study Group. Assessment, endoscopy, and treatment in patients with acute severe ulcerative colitis during the COVID-19 pandemic (PROTECT-ASUC): a multicentre, observational, case-control study. Lancet Gastroenterol Hepatol. Published online February 2, 2021. doi.org/10.1016/52468-1253(21)00016-9