COVID-19 in patients with inflammatory bowel disease: A systematic review of clinical data

Abstract

Background Great efforts by the scientific community are rapidly expanding the evidence on the clinical interplay between Covid-19 and inflammatory bowel disease (IBD). Aims We performed a systematic review of the literature on published Covid-19 cases occurring in patients with IBD. Methods PubMed Central/Medline and Embase were systemically searched for records up to May 31, 2020. Results 13 cohort studies and 5 single case reports were included in the qualitative synthesis. A cumulative number of approximately 800 patients with IBD and Covid-19 were identified. The case fatality rate ranged from 0% to 20.0%. Overall, immunomodulators and biologics were not associated with higher risk of Covid-19 or with negative outcomes, while the use of systemic corticosteroids was related to worse prognosis in some studies. Conclusions This systematic review highlighted two main points that may help clinicians dealing with IBD in reassuring their patients: (1) patients with IBD do not seem to be at higher risk of being infected by SARS-COV-2 than the general population; (2) in case of Covid-19, treatment with immunomodulators or biologics is not associated with worse prognosis, while systemic steroids are suspected to be potentially detrimental, even if more data are needed to confirm this point.

Care of inflammatory bowel disease patients during coronavirus disease‐19 pandemic using digital health‐care technology

“…The low frequency of COVID‐19 has been reported earlier in multiple uncontrolled studies from Spain, 24 Hong Kong, 25 Taiwan, 25 and Italy 26 . A systemic review also showed the same result 27 . However, our study also compared these data with a large number of non‐IBD controls.…”

“…6 Some studies even suggested that patients with IBD on treatment may have less severe COVID-19. 27 Although there is not enough data regarding the safety or adverse event profile with thiopurines in patients with IBD in the context of COVID-19 in the literature, our studydue to its small sample size and observational design-does not support the use of these agents in the context of SARS-CoV-2 infection either.…”

“…26 A systemic review also showed the same result. 27 However, our study also compared these data with a large number of non-IBD controls. Patients with IBD are at higher risk of SARS-CoV-2 infection as they are on multiple immunosuppressive medications and need to go to health-care facilities repeatedly, and chronically inflamed gut mucosa has been shown to have an increased abundance of SARS-CoV-2-binding receptors, such as angiotensin converting enzyme-2 (ACE-2).…”

Coronavirus (SARS-CoV-2) in gastroenterology and its current epidemiological situation: An updated review until January 2021

“…Table 1 (Tab. 1) (References in Table 1: Balaphas et al, 2020[ 2 ]; Boettler et al, 2020[ 3 ]; Colmenero et al, 2021[ 7 ]; Ding et al, 2004[ 8 ]; Elli et al, 2020[ 10 ]; Garland et al, 2020[ 12 ]; Jothimani et al, 2020[ 20 ]; Lee-Archer et al, 2020[ 22 ]; Macaluso and Orlando, 2020[ 24 ]; Monteleone and Ardizzone, 2020[ 26 ]; Nabil et al, 2020[ 27 ]; Onder et al, 2020[ 28 ]; Portincasa et al, 2020[ 30 ]; Rana, 2020[ 32 ]; RECOVERY Collaborative Group et al, 2020[ 33 ]; Wang et al, 2020[ 36 ]; Wu et al, 2020[ 38 ]; Yang et al, 2010[ 40 ]; Yang et al, 2019[ 41 ]; Yang et al, 2020[ 42 ]) shows the current updated status of COVID-19 in gastroenterology, liver injury, endoscopy, inflammatory bowel diseases (IBD), and imaging.…”

The impact of SARS-CoV-2 variants on IBD management

“…Our initial experience of COVID-19 has suggested that the medications used for patients with IBD do not seem to confer an increased risk of infection, severity, or poorer outcomes. 7 It might not be possible to currently confirm that the same is true for the new variants. Moreover, further mutations of SARS-CoV-2 are likely to develop in the future, which might lead to altered infectivity, virulence, and severity.…”