COVID-19 pneumonia was not detected in a cohort of Italian patients with inflammatory bowel disease (IBD), according to results of an observational study published in Gastroenterology.
A cohort of 522 patients with IBD (11% pediatric patients aged 7-18 years) in Bergamo, Italy between February 19th and March 23rd, 2020 were included in the study. Patients could contact clinicians through a dedicated phone number to report any complications, including symptoms of COVID-19. All patients that were admitted to Papa Giovanni XXIII Hospital underwent a nasopharyngeal swab to confirm infection with SARS-CoV-2.
The IBD cohort consisted of 64% ulcerative colitis and 36% Crohn’s disease cases. At the start of the viral outbreak, 58% of patients were prescribed anti-inflammatory medications (Salicylates), 17% were prescribed Thiopurines or Methotrexate, 16% were prescribed biologics (Infliximab, Adalimumab, Ustekinumab and Vedolizumab, or Golimumab), 3% were prescribed steroids, 2% were prescribed immunosuppressants (Tacrolimus, Cyclosporin, or Mofetil Micofenolate), and 4% were not prescribed any pharmacologic therapy. Patients were instructed not to alter their IBD treatment during the outbreak. This included patients who required treatment in the hospital (i.e., Infliximab and Vedolizumab).
The investigators did not observe any symptoms of COVID-19 in the IBD cohort, and none of the study participants were admitted to the hospital with a proven case of COVID-19. Over the same time period, 479 patients without IBD were admitted to the hospital due to COVID-19 pneumonia.
Using infection rates from Wuhan, China, where 86% of cases went undocumented, the investigators estimated that a total of 46220 individuals (4% of the population) were infected with SARS-CoV-2 in the province of Bergamo during the time of the study. Based on this model, 21 participants from their IBD cohort should have been infected with SARS-CoV-2.
One potential limitation of this study is that only patients with severe symptoms or who had an established contact with an infected individual were tested for COVID-19, so asymptomatic individuals were not accounted for.
The investigators concluded that they failed to detect any cases of COVID-19 pneumonia among the IBD cohort. These data, however, were unable to abstract infection rates among patients with IBD, which necessitates the need for further study of COVID-19 in this patient population.
Norsa L, Indriolo A, Sansotta N, et al. Uneventful course in IBD patients during SARS-CoV-2 outbreak in northern Italy. [available online April 2, 2020] Gastroenterology doi:10.1053/j.gastro.2020.03.062.