Patients with inflammatory bowel disease (IBD) who tested positive for SARS-CoV-2 had a good overall prognosis despite IBD maintenance treatment, according to results from an observational study published in Gastroenterology.
All patients (N=40) who tested positive for SARS-CoV-2 and were being treated for IBD at 5 sites in Spain between the 27th of February and the 8th of April 2020 were included in the study. Researchers assessed patients for IBD characteristics and current treatment, contact with individuals who had a confirmed diagnosis of COVID-19, clinical manifestations, and radiological and laboratory findings. Presence of pneumonia was stratified according CURB-65 scores and oxygen saturation.
Researchers treated patients with mild COVID-19 symptoms using hydroxychloroquine, first with 400 mg on day 1 then 200 mg until day 5. Patients with moderate to severe symptoms, including those with comorbidities or who were older than 60 years of age, were treated with lopinavir/ritonavir 200/50 mg initially; however, recent data on the use of these medications led researchers to later abandon this treatment option. Patients with worsening symptoms were prescribed systemic steroids and/or the biologics Tocilizumab or Anakinra.
The observed symptoms of SARS-CoV-2 were fever (77%), cough (67%), and diarrhea (21%). More patients positive for SARS-CoV-2 were undergoing immunomodulator (28%) rather than biologic (18%) monotherapies. After confirmation of COVID-19 infection, 82% of patients treated with immunomodulators and 43% treated with biologics discontinued IBD maintenance therapy.
None of the 40 patients were admitted to the intensive care unit or required mechanical ventilation. A total of 2 patients (7.6%) experienced gastrointestinal intolerance of the lopinavir/ritonavir treatment. A total of 2 deaths (5%) from SARS-CoV-2-related acute respiratory distress were reported among the patients. One of these deaths involved an elderly patient with diabetes, prostate adenocarcinoma, and ulcerative proctitis comorbidities undergoing Mesalamine treatment. The second death involved another elderly patient with dementia and left-sided ulcerative colitis who was being treated with Mesalamine and Methotrexate.
A limitation of the study was its short observational period and small sample size.
The investigators concluded that the overall prognosis of patients with IBD and confirmed infection with SARS-CoV-2 test was good. Although half of the patients with IBD required hospitalization, none advanced to the intensive care unit. These data indicated that immunomodulator or biologic therapy did not increase the risk for infection with COVID-19.
Disclosures: Some authors declared receiving consulting or funding from the pharmaceutical industry. A complete list of disclosures can be found in the original study.
Rodríguez-Lago I, Ramírez de la Picscina P, Elorza A, et al. Characteristics and prognosis of patients with inflammatory bowel disease during the SARS-CoV-2 pandemic in the Basque Country (Spain) [available online April 21, 2020]. Gastroenterology. doi:10.1053/j.gastro.2020.04.043s