High Asymptomatic COVID-19 Infection Rate Among Patients Treated With Biologics for Inflammatory Bowel Disease

Is treatment of inflammatory bowel disease (IBD) with biologic therapies harmful during infection with COVID-19?

Treatment with biologic therapies that blocked tumor necrosis factor-a and interferon-g did not appear to be harmful during infection with novel coronavirus 2019 (COVID-19). These findings, from a retrospective study, were published in Gastroenterology.

All patients (N=103; 12.6% adolescents) with inflammatory bowel disease (IBD) who were being treated at Papa Giovanni XXIII Hospital in Bergamo, Italy, were recruited for this study. Patients were being treated with infliximab, adalimumab, golimumab, ustekinumab, or vedolizumab. Patients were advised to maintain their treatment during the viral pandemic. Patients were screened for infection when they developed symptoms and were followed from March 4 through July 10, 2020.

All reported COVID-19 symptoms were mild, and no study participants required hospitalization. Most patients (87%) underwent serologic testing. A total of 21% of patients were positive for immunoglobulin G, immunoglobulin M, or both. No pediatric patients tested positive.

Compared with a control group of healthcare professionals, no deviations in viral test positivity were observed (P >.05).

A positive serological test result was significantly associated with sex (women vs men, 68.4% vs 31.6%; P =.032) and age (median 50.0 vs 34.0 years; P =.020). The investigators observed that age had a 5-fold increased risk for a positive serology result (47 years older vs 28 years younger).

The asymptomatic rate among individuals with seropositive COVID-19 tests was 58%. Two patients with positive test results underwent chest computed tomography and were found to have no pulmonary involvement.

A limitation of the study was that not all patients were tested, making unclear the overall infection rate of COVID-19 among the entire IBD patient population. From the data that was collected, the infection rate (21%) appeared to be similar to that of the general Italian population (24%).

Biologic therapy appeared to be safe during the global COVID-19 pandemic. However, the high rate of asymptomatic infection among patients with IBD was concerning. Patients being treated with biologics have frequent visits to the hospital. These data indicated that patients should undergo COVID-19 screening before hospital visits to avoid intrahospital transmissions regardless of symptoms.

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Norsa L, Cosimo P, Indriolo A, et al. Asymptomatic SARS-CoV-2 infection in patients with inflammatory bowel disease under biologic treatment [published online August 1, 2020]. Gastroenterology. doi: 10.1053/j.gastro.2020.08.046