Risk for Severe COVID-19 Not Elevated in Patients with Inflammatory Bowel Disease

Patients with inflammatory bowel disease had a similar risk for and outcomes from coronavirus disease 2019 as those in the general population.

Patients with inflammatory bowel disease (IBD) had a similar risk for and outcomes from coronavirus disease 2019 (COVID-19) as those in the general population. These findings from a population-based, retrospective, cohort study were published in Gastroenterology.

Researchers performed a real-time analysis of electronic health records (EHR) from more than 40 million patients worldwide with (n=232) and without IBD (n=19,776) who also tested positive for COVID-19 between January 20 and May 26, 2020.

Data on medication use was available for 166 patients with IBD. These patients were being treated with biologics (n=37), immunomodulators (n=34), aminosalicylate (n=32), and corticosteroids (n=111). Immune-mediated therapies were not associated with an increased risk for developing severe COVID-19 (risk ratio [RR], 1.01; 95% CI, 0.62-1.65; P =.97). The researchers did observe an increased risk for severe COVID-19 in patients who received corticosteroids up to 3 months prior to their coronavirus diagnosis (30.98% vs 19.25%; RR, 1.60; 95% CI, 1.01-2.57; P =.04).

More patients with IBD reported gastrointestinal symptoms — specifically nausea and vomiting — than patients without IBD (10.77% vs 4.31%; P <.01), diarrhea (19.00% vs 5.14%; P <.01), and abdominal pain (7.75% vs 2.70%; P <.01).

The researchers performed propensity score matching in order to correct their dataset for significant differences between cohorts in sex, race, and comorbidities including hypertension, asthma, chronic lower respiratory disease, diabetes mellitus, ischemic heart disease, chronic kidney disease, and heart failure.

After balancing the cohorts, risk for severe COVID-19 infection was not significantly different (RR, 0.93; 95% CI, 0.68-1.27; P =.66). However, the patients with IBD who had a severe COVID-19 infection were older and had multiple comorbidities compared with patients with severe COVID-19 without IBD.

Limitations of the study were similar to those of any retrospective study based on electronic health records. The researchers were unable to control for multiple factors and it was unclear if data were missing.

The study authors concluded that patients with IBD were not at elevated risk for developing a severe COVID-19 infection despite the long-term use of immunosuppressive drugs. Based on these findings, the investigators suggested that patients with IBD should continue treatment to avoid disease flare-ups.

Disclosures: Some authors declared receiving consulting or funding from the pharmaceutical industry. A complete list of disclosures can be found in the original study.

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Singh S, Khan A, Chowdhry M, et al. Risk of severe COVID-19 in patients with inflammatory bowel disease in United States. A multicenter research network study [published online June 6, 2020]. Gastroenterology. doi:10.1053/j.gastro.2020.06.003