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Bowel Disease (SECURE-IBD) database, an international, collaborative database created to monitor COVID-19 outcomes in patients with inflammatory bowel disease (IBD), has previously reported that corticosteroids and mesalamine or sulfasalazine are associated with an increased risk of severe COVID-19 and tumor necrosis factor (TNF) antagonists do not impact risk. 1 A follow-up report observed that patients on combination therapy with TNF antagonists and thiopurines appeared to be at higher risk of severe COVID-19. 2 However, at that time, the number of reported cases was too low to fully evaluate the risk of other IBD therapies. As the cases reported to SECURE-IBD have increased substantially, more granular analyses evaluating other IBD medication classes (including combination therapies) and adjusting for more covariates are possible. In this study, we compared associations between multiple medication classes and adverse COVID-19 outcomes in the SECURE-IBD database.We analyzed reports to SECURE-IBD from inception (March 13, 2020) through May 21, 2021. Details regarding data and analysis are provided in the Supplementary Material.Demographic and clinical characteristics of 6144 included reports stratified by medication type are provided in Supplementary Table 1. Figure 1 summarizes the independent associations of medication classes on adverse COVID-19 outcomes among all cases reported to SECURE-IBD. Systemic corticosteroids were associated and methotrexate was marginally associated with an increased odds of hospitalization or death or both. Medications associated with a decreased odds of COVID-19-related hospitalization or death or both included TNF, interleukin-12/23, and integrin antagonists. Systemic corticosteroids were significantly associated with increased odds of severe COVID-19, and TNF and interleukin-12/23 antagonists were associated with a decreased odds of severe COVID-19. Systemic corticosteroids were associated with increased odds of death due to COVID-19, and biologics were not. Notably, there were no statistically significant associations between mesalamine or sulfasalazine and any adverse COVID-19 outcome. We also observed that TNF antagonist and thiopurine combination therapy was associated with a significantly increased risk of hospitalization or death (adjusted odds ratio [aOR], 1.82; 95% confidence interval [CI], 1.26-2.62), but not severe 1.63; 95% CI,. In contrast, a combination of TNF antagonist and methotrexate was not significantly associated with risk of either adverse COVID-19 outcome (aOR, 0.82; 95% CI, 0.42-1.60 and OR, 2.44; 95% CI, 0.55-10.74).

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Goals To estimate hepatocellular carcinoma surveillance in the Medicaid cirrhotic population. Background Most studies predate 2005 AASLD surveillance recommendations and do not examine the primary target population, cirrhotics. Study For 2006-2007 we identified adults with at least one cirrhosis International Classification of Disease code and 15 months of continuous enrollment in North Carolina Medicaid, recording claims for abdominal ultrasound, computed tomography, magnetic resonance imaging, and alpha-fetoprotein testing. We used multi-variable logistic regression to identify factors independently associated with imaging. Results Five-thousand sixty one subjects (5,061) were identified: mean age 54 years, 54% male, 35% African-American, 56% White. Cirrhosis risk factors were alcohol (59%), hepatitis C (30%), hepatitis B (4%), other (18%), and unknown (24%). Only 26% had at least one imaging test. Just 12% of those not hospitalized or seen in an emergency department had any imaging. Care in an academic facility, younger age, female gender, viral hepatitis, and Medicare co-insurance were positively associated with imaging. Twenty-one percent saw a gastroenterologist which increased the odds of undergoing imaging [Odds Ratio (O.R.) 2.81, 95% Confidence Interval (C.I.) 2.32, 3.41] while primary care visits did not (O.R. 0.94, 95% C.I. 0.76, 1.16). Conclusions Only a quarter of North Carolina Medicaid cirrhotics had abdominal imaging over a 15 month period, and many tests may have occurred without surveillance intent. Gastroenterology visits nearly tripled the odds of imaging, but primary care visits had no effect. Efforts to improve surveillance rates in cirrhotic patients should target primary care and increased access to sub-specialty care.