COVID-19 in IBD: The experience of a single tertiary IBD center

Abstract

BACKGROUND Italy has been one of the most affected countries in the world by COVID-19. There has been increasing concern regarding the impact of COVID‐19 on patients with inflammatory bowel disease (IBD), particularly in patients treated with immunosuppressants or biologics. The aim of our study is to understand the incidence of COVID-19 in a large cohort of patients with IBD. Furthermore, we analyzed possible risk factors for infection and severity of COVID-19. METHODS This was an observational study evaluating the impact of COVID-19 on IBD patients in a single tertiary center. A 23 multiple-choice-question anonymous survey was administered to 1200 patients with IBD between March 10 th and June 10 th 2020. RESULTS 1158 questionnaires were analyzed. The majority of patients had Crohn's disease (CD) (60%) and most of them were in clinical remission. Among the 26 patients (2.2%) who tested positive for COVID-19, only 5 (3CD) were on biological treatment and none required hospitalization. Two patients died and were on treatment with mesalazine only. Of the 1158 patients, 521 were on biological therapy , which was discontinued in 85 (16.3%) and delayed in 195 patients (37.4%). A worsening of IBD symptoms was observed in 200 patients on biological therapy (38.4%). Most of these patients, 189 (94.5%), had stopped or delayed biological treatment, while 11 (5.5%) had continued their therapy regularly (p<0.001). CONCLUSIONS Our data are in line with the current literature and confirm a higher incidence compared to the general population. Biological therapy for IBD seems to not be a risk factor for infection and should not be discontinued in order to avoid IBD relapse.

Inflammatory Bowel Disease patients requiring surgery can be treated in referral centres regardless of the COVID-19 status of the hospital: results of a multicentric European study during the first COVID-19 outbreak (COVIBD-Surg)

“…Previous evidence regarding a higher risk of viral infections in IBD patients on thiopurine therapy [ 12 ], and a greater tissue concentration of angiotensin-converting enzyme 2 in patients with active intestinal inflammation [ 13 ], contributed to raising concerns regarding the threat of severe illness in IBD patients in the case of SARS-CoV-2 infection. Only in subsequent months did additional population studies show that patients affected by IBD had a risk of contracting coronavirus infection similar to that of the general population [ 14 , 15 ], regardless of the biological therapy [ 16 – 18 ]. However, it is still not known whether the outcomes of surgery performed on IBD patients during the period of highest pressure to the healthcare system were affected by the environment of a COVID-19-treatment hospital, and whether IBD surgery should be performed only in COVID-19-free facilities.…”

Administration of COVID-19 vaccines in immunocompromised patients

“…Studies have shown thatpotential risk factors for SARS-CoV-2 infection include age, nutritional status, high comorbidities,andIBD activity [143] .Some studiesdemonstratedno association between IBD treatments and COVID-19 severe infection or mortality [144] , [145] . On the other hand, inthe SECURE-IBDclinical trial,theuse of systemic corticosteroids and sulfasalazine wasshown as serious risk factors for poor clinicaloutcomes in COVID-19 patients [146] , [147] .…”

COVID-19 and its effects on the digestive system

“…In a multicenter study from eight major gastrointestinal centers in Lombardy, Italy, IBD patients were not reported to have an increased risk of COVID-19 specific symptoms or more severe disease as compared with a control group of gastroenterology patients[ 65 ]. Another observational study confirmed that patients with IBD had a higher risk of COVID-19 incidence as compared to the general population and that tumor necrosis factor (TNF) antagonists may reduce the severity of COVID-19[ 66 ]. Singh et al [ 67 ] indicated no significant differences in the composite outcome of hospitalization or mortality between COVID-19 patients with IBD and those without.…”