Corticosteroids, But Not TNF Antagonists, Are Associated With Adverse COVID-19 Outcomes in Patients With Inflammatory Bowel Diseases: Results From an International Registry

Abstract

This article has an accompanying continuing medical education activity, also eligible for MOC credit, on page e12. Learning Objective: Upon completion of this CME activity, successful learners will be able to discuss how steroids are associated with severe outcomes from COVID-19 among patients with inflammatory bowel disease (IBD). See Covering the Cover synopsis on page 407. BACKGROUND AND AIMS: The impact of Coronavirus disease 2019 (COVID-19) on patients with inflammatory bowel disease (IBD) is unknown. We sought to characterize the clinical course of COVID-19 among patients with IBD and evaluate the association among demographics, clinical characteristics, and immunosuppressant treatments on COVID-19 outcomes. METHODS: Surveillance Epidemiology of Coronavirus Under Research Exclusion for Inflammatory Bowel Disease (SECURE-IBD) is a large, international registry created to monitor outcomes of patients with IBD with confirmed COVID-19. We calculated age-standardized mortality ratios and used multivariable logistic regression to identify factors associated with severe COVID-19, defined as intensive care unit admission, ventilator use, and/or death. RESULTS: 525 cases from 33 countries were reported (median age 43 years, 53% men). Thirty-seven patients (7%) had severe COVID-19, 161 (31%) were hospitalized, and 16 patients died (3% case fatality rate). Standardized mortality ratios for patients with IBD were 1.8 (95% confidence interval [CI], 0.9-2.6), 1.5 (95% CI, 0.7-2.2), and 1.7 (95% CI, 0.9-2.5) relative to data from China, Italy, and the United States, respectively. Risk factors for severe COVID-19 among patients with IBD included increasing age (adjusted odds ratio [aOR], 1.04; 95% CI, 1.01-1.02), 2 comorbidities (aOR, 2.9; 95% CI, 1.1-7.8), systemic corticosteroids (aOR, 6.9; 95% CI, 2.3-20.5), and sulfasalazine or 5-aminosalicylate use (aOR, 3.1; 95% CI, 1.3-7.7). Tumor necrosis factor antagonist treatment was not associated with severe COVID-19 (aOR, 0.9; 95% CI, 0.4-2.2). CONCLUSIONS: Increasing age, comorbidities, and corticosteroids are associated with severe COVID-19 among patients with IBD, although a causal relationship cannot be definitively established. Notably, tumor necrosis factor antagonists do not appear to be associated with severe COVID-19.

Prevalence and clinical features of COVID-19 in a large cohort of 199 patients with sarcoidosis

“…85% of COVID-19 patients and 75% of hospitalized patients compared to 9% and 29% respectively in the study by Haberman et al (18). Our results are consistent with those of previous studies showing that the use of systemic corticosteroids is a risk factor for a severe course of COVID-19, particularly in inflammatory bowel diseases (19). None of the hospitalized patients was a daily smoker or ex-smoker, which is consistent with several studies finding a low proportion of smokers among patients with a moderate to severe outcome.…”

“…Coronavirus disease (COVID- 19), mediated by SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) is responsible for a major health crisis worldwide. COVID-19 can be complicated with a severe acute respiratory syndrome (ARDS) and multi-organ failure.…”

Alimentary System is Directly Attacked by SARS-COV-2 and Further Prevent Immune Dysregulation Caused by COVID-19

“…ESR generally points to bacterial infection. We believed that intestinal ora being interrupted by SARS-COV-2 could not be excluded, as could be observed in other reports (22,23).…”

Infection risk of dermatologic therapeutics during the COVID‐19 pandemic: an evidence‐based recalibration

“…The study demonstrated a strong positive association between systemic corticosteroid use and increased mortality/ICU admission of COVID‐19 patients. The study also indicated that TNF antagonist, methotrexate, and IL‐12/23 inhibitors do not appear to be associated with severe COVID‐19 100 . We note that the effects of low‐dose dexamethasone against COVID‐19 are currently being evaluated in the RECOVERY trial 101 …”

“…Pooled data from 71 RCTs for steroids vs. no steroids found the relative risk of infections was increased by 60% (95% CI 30–90) for those receiving steroids (Table 4). 99 In a large cohort of patients with inflammatory bowel disease that was collected through an international registry, the outcomes of the use of high‐dose corticosteroids, among other immunosuppressives, in COVID‐19‐positive patients was evaluated 100 . The study demonstrated a strong positive association between systemic corticosteroid use and increased mortality/ICU admission of COVID‐19 patients.…”