Inflammatory Bowel Disease Not Associated With Increased Risk for Severe COVID-19 Outcomes

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Patients with IBD may be at an increased risk for severe COVID-19 owing to their immunosuppressant medications or the chronic inflammatory disease state.

According to study data published in Gastroenterology, participants with inflammatory bowel disease (IBD) were not at increased risk for poor outcomes from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Immune-mediated therapy for IBD did not appear to increase risk for mortality or severe infection. However, corticosteroid use in the 3 months prior to coronavirus disease (COVID-19) diagnosis was moderately associated with poorer outcomes.

Investigators extracted data from TriNetX, a database comprising the electronic health records of over 40 million patients around the world. Participants in the United States who were diagnosed with COVID-19 between January 20, 2020 and May 26, 2020 were eligible for inclusion. Participants with IBD were identified using the appropriate diagnostic codes. The primary outcome was the risk for severe COVID-19 disease, defined by hospital admission and/or 30-day mortality post-diagnosis. Participants with IBD were propensity score matched by demographics and comorbid conditions to those without IBD. Matched comorbid conditions included hypertension, chronic lower respiratory diseases, diabetes, ischemic heart diseases, chronic kidney disease, and heart failure. COVID-19 outcomes were compared between the IBD and non-IBD groups using logistic regression.

The study cohort comprised 232 participants with IBD and 19,776 non-IBD controls who were diagnosed with COVID-19 during the study period. Mean ages were comparable between groups: 51.2 ± 18.1 years among participants with IBD and 49.5 ± 19.1 among those without IBD (P =.18). A greater proportion of participants with IBD were women (63.4% vs 55.30%; P =.01). Compared with controls, participants with IBD more frequently presented with vomiting (4.31% vs 10.77%), diarrhea (5.14% vs 8.19%), and abdominal pain (2.7% vs 7.7%) following SARS-CoV-2 infection (all P <.01). After propensity score matching, participants with IBD did not have an increased risk for severe COVID-19 outcomes (relative risk [RR], 0.93; 95% confidence interval [CI], 0.68-1.27; P =.66). In subgroup analyses, participants who received immune-mediated therapy for IBD were not at higher risk for COVID-19 than those who did not (RR, 1.01; 95% CI, 0.62-1.65; P =.97). However, in unadjusted analyses, participants with IBD who used corticosteroids within 3 months of COVID-19 diagnosis were more likely to have severe disease than participants who did not use corticosteroids (RR, 1.60; 95% CI, 1.01-2.57; P =.04).

These results suggest that IBD does not increase risk for severe COVID-19 disease, even among participants using immune-mediated therapies. As study limitations, investigators cited the use of a composite outcome measure rather than evaluating mortality and hospitalization separately. The composite outcome was chosen due to the small number of events. Additional research in a larger cohort is necessary to further elucidate the COVID-19 outcomes in people with IBD, particularly those who use corticosteroids.

“IBD patients in remission and on immunomodulators and biologics should stay on their medications and should exercise social distancing principles like the general population,” investigators wrote. “[However], IBD patients with advanced age, multiple comorbidities, or with a poorly controlled disease requiring corticosteroids…should be aggressively managed, given the increased risk of worse outcomes.”

Disclosure: One study author declared affiliations with the pharmaceutical industry.

Please see the original reference for a full list of authors’ disclosures.

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Singh S, Khan A, Chowdhry M, Bilal M, Kochhar GS, Clarke K. Risk of severe COVID-19 in patients with inflammatory bowel disease in United States. A multicenter research network study [published online June 2, 2020]. Gastroenterology. doi: 10.1053/j.gastro.2020.06.003