Assessment, endoscopy, and treatment in patients with acute severe ulcerative colitis during the COVID-19 pandemic (PROTECT-ASUC): a multicentre, observational, case-control study

Scheer, Sebastian; Walker, Gareth; Kennedy, Nicholas A.; Conley, Thomas; Patel, Kamal; Subramanian, Sreedhar; Kent, Alexandra; Segal, Jonathan; Brookes, Matthew; Bhala, Neeraj; Gonzalez, Haidee Aleman; Hicks, Lucy; Mehta, Shameer; Lamb, Christopher A

doi:10.1016/s2468-1253(21)00016-9

Cited by 26 publications

(23 citation statements)

References 40 publications

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Section: Introductionmentioning

confidence: 99%

“…5 Nonetheless, due to the lack of original research data, there is still much uncertainty about the implications of COVID-19 for patients with UC, especially for those with active disease. 6 Most importantly, guidelines covering this subgroup of patients are inconclusive at this moment, necessitating consensus-based recommendations in the absence of more evidence-based data. [7][8][9] In this report, we describe three consecutive patients with UC in the Netherlands who contracted COVID-19 and presented clinically with either a first presentation or flare of acute severe UC.…”

Section: Introductionmentioning

confidence: 99%

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Treatment of severe acute ulcerative colitis in SARS-CoV-2 infected patients: report of three cases and discussion of treatment options

Bourgonje

Linschoten

West

et al. 2021

Therap Adv Gastroenterol

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In the wake of the coronavirus disease 2019 (COVID-19) pandemic, it is unclear how asymptomatic severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2)-infected patients who present with acute severe ulcerative colitis (UC) can be treated effectively and safely. Standard treatment regimens consist of steroids, immunomodulatory drugs, and biological therapies, but therapeutic decision-making becomes challenging as there are uncertainties about how to deal with these drugs in patients with COVID-19 and active UC. Importantly, guidelines for this particular group of patients with UC are still lacking. To inform therapeutic decision-making, we describe three consecutive cases of patients with active UC and COVID-19 and discuss their treatments based on theoretical knowledge, currently available evidence and clinical observations. Three patients were identified through our national inflammatory bowel disease network [Initiative on Crohn’s and Colitis (ICC)] for whom diagnosis of SARS-CoV-2-infection was established by reverse transcription–polymerase chain reaction (RT-PCR) testing in nasopharynx, stools, and/or biopsies. Acute severe UC was diagnosed by clinical parameters, endoscopy, and histopathology. Clinical guidelines for SARS-CoV-2-negative patients advocate the use of steroids, calcineurin inhibitors, or tumor necrosis factor alpha (TNF-α)-antagonists as induction therapy, and experiences from the current three cases show that steroids and TNF-α-antagonists could also be used in patients with COVID-19. This could potentially be followed by TNF-α-antagonists, vedolizumab, or ustekinumab as maintenance therapy in these patients. Future research is warranted to investigate if, and which, immunomodulatory drugs should be used for COVID-19 patients that present with active UC. To answer this question, it is of utmost importance that future cases of patients with UC and COVID-19 are documented carefully in international registries, such as the SECURE-IBD registry.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Treatment of severe acute ulcerative colitis in SARS-CoV-2 infected patients: report of three cases and discussion of treatment options

Bourgonje

Linschoten

West

et al. 2021

Therap Adv Gastroenterol

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“…Our systematic search of the literature allowed us to identify 37 case reports and case series 20‐56 and 11 studies that corresponded to our research question but their data were provided descriptively and an effect measure could not be calculated 21,57‐66 . These data are included in Table S1.…”

Section: Resultsmentioning

confidence: 99%

Systematic review with meta‐analysis: COVID‐19 outcomes in patients receiving anti‐TNF treatments

Kokkotis

Kitsou

Xynogalas

et al. 2021

Aliment Pharmacol Ther

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Summary Background Accumulating evidence suggests a beneficial effective of tumour necrosis factor‐alpha (TNF‐α) inhibitors on the outcomes of COVID‐19 disease, which, however is not validated by all studies. Aims To perform a systematic review and meta‐analysis of existing reports to investigate the impact of anti‐TNF treatments on the clinical outcomes of COVID‐19 patients. Methods A systematic search at PubMed and SCOPUS databases using specific keywords was performed. All reports of COVID‐19 outcomes for patients receiving anti‐TNF therapy by September 2021 were included. Pooled effect measures were calculated using a random‐effects model. The Newcastle Ottawa Scale for observational studies was used to assess bias. Studies that were not eligible for meta‐analysis were described qualitatively. Results In total, 84 studies were included in the systematic review, and 35 were included in the meta‐analysis. Patients receiving anti‐TNF treatment, compared to non‐anti‐TNF, among COVID‐19 cases had a lower probability of hospitalisation (eight studies, 2555 patients, pooled OR = 0.53, 95% CI: 0.42‐0.67, I2 = 0) and severe disease defined as intensive care unit admission or death (two studies, 1823 patients, pooled OR = 0.63, 95% CI: 0.41‐0.96, I2 = 0), after adjustment for validated predictors of adverse disease outcomes. No difference was found for the risk for hospitalisation due to COVID‐19 in populations without COVID‐19 for patients receiving anti‐TNF treatment compared to non‐anti‐TNF (three studies, 5 994 958 participants, pooled risk ratio = 0.97, 95% CI: 0.68‐1.39, I2 = 20) adjusted for age, sex and comorbidities. Conclusions TNF‐α inhibitors are associated with a lower probability of hospitalisation and severe COVID‐19 when compared to any other treatment for an underlying inflammatory disease.

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“…Für die Colitis ulcerosa zeigen aktuelle Daten aus dem Vereinigten Königreich eine vergleichbare Inzidenz von Notfallkolektomien bei allerdings deutlich geringerer Häufigkeit laparoskopischer Operationen im Vergleich zur Vorpandemie (53 % vs. 76 %; [ 26 ]). Trotz der häufigeren Nutzung von Kortikosteroiden zeigte sich erfreulicherweise keine Häufung von COVID-19-Fällen bei diesen Patienten.…”

Section: Notfallchirurgieunclassified

Auswirkung von COVID-19 auf die elektive und notfallmäßige Kolorektalchirurgie

Lock

Köhler

Germer

et al. 2021

Chirurg

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In diesem Beitrag-Methodik -Präoperative Risikoevaluation in Bezug auf COVID 19 -Kolorektales Karzinom Vorsorgeuntersuchungen • Therapiestrategien in der Pandemie • Einfluss auf die Prognose -Notfallchirurgie Appendizitis • Divertikulitis • Colitis ulcerosa -Schlussfolgerungen und Ausblick QR-Code scannen & Beitrag online lesen Zusammenfassung Hintergrund: Die SARS-CoV-2("severe acute respiratory syndrome coronavirus 2")-Pandemie hat zu weitreichenden Veränderungen in die Versorgungsrealität praktisch aller medizinischen Fachbereiche geführt. Ziel der Arbeit: Empfehlungen zum perioperativen Management in Bezug auf SARS-CoV-2 und Darstellung von Auswirkungen auf die kolorektale Chirurgie. Material und Methoden: Es wurde eine systematische Literaturrecherche durchgeführt. Ergebnisse: Perioperative Infektionen mit SARS-CoV-2 führen zu einer deutlich erhöhten postoperativen Mortalität und müssen durch ein strukturiertes Maßnahmenbündel verhindert werden. Die weltweiten Einschränkungen bei Vorsorgeuntersuchungen und Therapieangeboten können mittelfristig eine erhöhte Mortalität durch kolorektale Karzinome zur Folge haben. Auch in der Notfallversorgung zeigt sich ein erheblicher Rückgang der Fallzahlen mit der Gefahr verspäteter Interventionen. Diskussion: Eine rasche Normalisierung der klinischen Behandlungspfade in der Kolorektalchirurgie ist erforderlich, um langfristige negative Folgen für die Patienten zu vermeiden.

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Assessment, endoscopy, and treatment in patients with acute severe ulcerative colitis during the COVID-19 pandemic (PROTECT-ASUC): a multicentre, observational, case-control study

Cited by 26 publications

References 40 publications

Treatment of severe acute ulcerative colitis in SARS-CoV-2 infected patients: report of three cases and discussion of treatment options

Treatment of severe acute ulcerative colitis in SARS-CoV-2 infected patients: report of three cases and discussion of treatment options

Systematic review with meta‐analysis: COVID‐19 outcomes in patients receiving anti‐TNF treatments

Auswirkung von COVID-19 auf die elektive und notfallmäßige Kolorektalchirurgie

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