Clinical Outcomes of Covid-19 in Patients With Inflammatory Bowel Disease: A Nationwide Cohort Study

Derikx, Lauranne; Lantinga, Marten A.; Jong, Dirk J. de; Dop, Willemijn A. van; Creemers, Rob H.; Römkens, Tessa E H; Jansen, Jeroen M.; Mahmmod, Nofel; West, Rachel; Tan, Adriaan C.; Bodelier, Alexander; Gorter, Moniek H P; Boekema, Paul J.; Halet, Eric; Horjus, Carmen S.; Dijk, Maarten A van; Hirdes, Meike M.; Stippel, Ludger S.M. Epping; Jharap, Bindia; Lutgens, M. W. M. D.; Rüssel, Maurice G.; Gilissen, Lennard P L; Nauta, Sjoukje; Bodegraven, Adriaan A. van; Hoentjen, Frank

doi:10.1093/ecco-jcc/jjaa215

Cited by 65 publications

(103 citation statements)

References 18 publications

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“…We found an incidence of hospitalisation for COVID‐19 per 100 000 IBD patients during COVID‐19 first wave of 220 (600/268 185). In population‐based studies, this rate over the same period was 80 (15/19 717) in Denmark 10 and 170 (59/34 763) in the Netherlands 11 . These results are consistent with the incidence of hospitalisation for COVID‐19 in the general population over the same period: 134 per 100 000 in France, 12 39 in Denmark 13 and 84 in the Netherlands 11 …”

Section: Discussionsupporting

confidence: 79%

Risk of severe COVID‐19 in patients treated with IBD medications: a French nationwide study

Meyer

Semenzato

Zureik

et al. 2021

Aliment Pharmacol Ther

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Summary Background Recently, the SECURE‐IBD study, based on a physician‐reported registry, suggested that thiopurines, either alone or combined with anti‐TNF, may increase risk of severe COVID‐19. Aims To compare the risk of severe COVID‐19 according to IBD medications in a large and unselected population. Methods Using the French national health data system, the risks of hospitalisation and of death or mechanical ventilation for COVID‐19 from 15 February 2020 to 31 August 2020 in IBD patients were compared according to IBD treatment (immunomodulators and biologics), using multivariable Cox models adjusted for socio‐demographic characteristics, budesonide/corticosteroids and aminosalicylates use, and comorbidities. Results Among 268 185 IBD patients, 600 were hospitalised for COVID‐19 and 111 of them died or were mechanically ventilated (including 78 deaths). In multivariable analysis, the risk of hospitalisation for COVID‐19 did not differ according to IBD treatment category, with adjusted Hazard Ratios (aHR, unexposed patients used as reference) of 0.94 (95%CI: 0.66‐1.35) for immunomodulator monotherapy, 1.05 (0.80‐1.38) for anti‐TNF monotherapy, 0.80 (0.38‐1.69) for anti‐TNF combination therapy, 1.06 (0.55‐2.05) for vedolizumab and 1.25 (0.64‐2.43) for ustekinumab. Similarly, the risk of death or mechanical ventilation for COVID‐19 did not differ according to IBD treatment. Conclusions Immunomodulators and biologics prescribed in patients with IBD do not appear to increase the severity of COVID‐19 infection.

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Section: Discussionsupporting

confidence: 79%

Risk of severe COVID‐19 in patients treated with IBD medications: a French nationwide study

Meyer

Semenzato

Zureik

et al. 2021

Aliment Pharmacol Ther

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“…report that IBD patients undergoing testing for COVID‐19 were less often positive (2.5%) than in the overall population (3.7% positivity). Derikx et al 15 . reported a lower risk of incident COVID‐19, but a higher risk of COVID‐19 hospital admission in IBD patients, but their study did not adjust for sex, age or other confounders.…”

Section: Introductionmentioning

confidence: 93%

Inflammatory bowel disease and risk of severe COVID‐19: A nationwide population‐based cohort study in Sweden

et al. 2021

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Background There are concerns that individuals with chronic immune‐mediated diseases are at increased risk of COVID‐19 and related severe adverse outcome, including intensive care admission or death. We aimed to explore the absolute and relative risk of severe COVID‐19 in inflammatory bowel disease (IBD). Methods This population‐based cohort study used nationwide registers in Sweden, with 67,292 individuals with a diagnosis of IBD 1969–2017 (Crohn's disease, n = 21,599; ulcerative colitis: n = 43,622; IBD‐unclassified: n = 2071) and alive on 1 February 2020. Patients with IBD were matched to up to five controls from the general population ( n = 297,910). Cox regression estimated hazard ratios (HRs) for (i) hospital admission with laboratory‐confirmed COVID‐19 as the primary diagnosis, and (ii) severe COVID‐19 (composite outcome consisting of (a) COVID‐19 intensive care admission, or (b) death from COVID‐19 or (c) death within 30 days of COVID‐19 hospital admission), were calculated. Analyses were conditioned on age, sex, calendar period, and county and adjusted for other comorbidities. Results Between 1 February and 31 July 2020, 179 (0.27%) IBD patients and 500 (0.17%) general population controls were admitted to hospital with COVID‐19 (adjusted HR [aHR] = 1.43; 95% CI = 1.19–1.72). The corresponding numbers for severe COVID‐19 was 65 (0.10%) and 183 (0.06%; aHR = 1.11; 95% CI = 0.81–1.52). Adjusted HRs were similar in Crohn's disease and ulcerative colitis. In a propensity score‐matched model taking comorbidity into account until 2016, the increased risk for COVID‐19 hospital admission remained (aHR = 1.32; 1.12–1.56), but there was no increased risk of severe COVID‐19 (aHR = 1.12; 0.85–1.47). Conclusions While individuals with IBD were more likely to be admitted to hospital for COVID‐19 than the general population, the risk of severe COVID‐19 was not higher.

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“…Furthermore, we observed some clinically instructive results by MR analysis. Elevated levels of CRP and IL-10 were commonly happened in severe COVID-19 patients [33], and IBD patients were at higher risk of developing severity [34]; in contrast, vasodilator use and vitamin D supplements might reduce the risk of COVID-19 infections and mortality [35,36]. These clinical observations were consistent with their causal associations with ARDS development, which may guide the ARDS care management, especially during COVID-19 severe progression.…”

Section: Discussionmentioning

confidence: 52%

Integrative omics provide biological and clinical insights into acute respiratory distress syndrome

Garcia

Christie

et al. 2021

Intensive Care Med

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Purpose: Acute respiratory distress syndrome (ARDS) is accompanied by a dysfunctional immune-inflammatory response following lung injury, including during coronavirus disease 2019 . Limited causal biomarkers exist for ARDS development. We sought to identify novel genetic susceptibility targets for ARDS to focus further investigation on their biological mechanism and therapeutic potential.Methods: Meta-analyses of ARDS genome-wide association studies were performed with 1250 cases and 1583 controls in Europeans, and 387 cases and 387 controls in African Americans. The functionality of novel loci was determined in silico using multiple omics approaches. The causality of 114 factors potentially involved in ARDS development was assessed using Mendelian Randomization analysis.Results: There was distinct genetic heterogeneity in ARDS between Europeans and African Americans. rs7967111 at 12p13.2 was functionally associated with ARDS susceptibility in Europeans (odds ratio = 1.38; P = 2.15 × 10 -8 ). Expression of two genes annotated at this locus, BORCS5 and DUSP16, was dynamic but ultimately decreased during ARDS development, as well as downregulated in immune cells alongside COVID-19 severity. Causal inference implied that comorbidity of inflammatory bowel disease and elevated levels of C-reactive protein and interleukin-10 causally increased ARDS risk, while vitamin D supplementation and vasodilator use ameliorated risk. Conclusion:Our findings suggest a novel susceptibility locus in ARDS pathophysiology that implicates BORCS5 and DUSP16 as potentially acting in immune-inflammatory processes. This locus warrants further investigation to inform the development of therapeutic targets and clinical care strategies for ARDS, including those induced by

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Clinical Outcomes of Covid-19 in Patients With Inflammatory Bowel Disease: A Nationwide Cohort Study

Cited by 65 publications

References 18 publications

Risk of severe COVID‐19 in patients treated with IBD medications: a French nationwide study

Risk of severe COVID‐19 in patients treated with IBD medications: a French nationwide study

Inflammatory bowel disease and risk of severe COVID‐19: A nationwide population‐based cohort study in Sweden

Integrative omics provide biological and clinical insights into acute respiratory distress syndrome

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