Effect of IBD medications on COVID-19 outcomes: results from an international registry

Abstract

ObjectiveWe sought to evaluate COVID-19 clinical course in patients with IBD treated with different medication classes and combinations.DesignSurveillance Epidemiology of Coronavirus Under Research Exclusion for Inflammatory Bowel Disease (SECURE-IBD) is a large, international registry created to monitor outcomes of IBD patients with confirmed COVID-19. We used multivariable regression with a generalised estimating equation accounting for country as a random effect to analyse the association of different medication classes with severe COVID-19, defined as intensive care unit admission, ventilator use and/or death.Results1439 cases from 47 countries were included (mean age 44.1 years, 51.4% men) of whom 112 patients (7.8%) had severe COVID-19. Compared with tumour necrosis factor (TNF) antagonist monotherapy, thiopurine monotherapy (adjusted OR (aOR) 4.08, 95% CI 1.73 to 9.61) and combination therapy with TNF antagonist and thiopurine (aOR 4.01, 95% CI 1.65 to 9.78) were associated with an increased risk of severe COVID-19. Any mesalamine/sulfasalazine compared with no mesalamine/sulfasalazine use was associated with an increased risk (aOR 1.70, 95% CI 1.26 to 2.29). This risk estimate increased when using TNF antagonist monotherapy as a reference group (aOR 3.52, 95% CI 1.93 to 6.45). Interleukin-12/23 and integrin antagonists were not associated with significantly different risk than TNF antagonist monotherapy (aOR 0.98, 95% CI 0.12 to 8.06 and aOR 2.42, 95% CI 0.59 to 9.96, respectively).ConclusionCombination therapy and thiopurines may be associated with an increased risk of severe COVID-19. No significant differences were observed when comparing classes of biologicals. These findings warrant confirmation in large population-based cohorts.MKH should be changed to MDK for co-last author line

SARS-CoV-2 vaccination for patients with inflammatory bowel diseases: recommendations from an international consensus meeting

“…These risks continue to be explored in registries such as Surveillance Epidemiology of Coronavirus Under Research Exclusion (SECURE) and other population-based studies. 24 …”

COVID-19 and IBD drugs: should we change anything at the moment?

“…4 Ungaro and colleagues now report an expanded analysis on the first 1439 cases. 5 These cases were 34.5% from the USA, 51.4% male individuals and 82.1% white. Overall, 38.5% of patients were on anti-tumour necrosis factor (TNF) therapy and 30.6% were taking a 5-amino salicylic acid (5-ASA) preparation.…”

“…The major finding was of an increased risk of severe COVID-19 outcomes in patients taking thiopurines. 5 Using anti-TNF monotherapy as a reference arm, thiopurine monotherapy and anti-TNF plus thiopurine combination therapy were both associated with worse outcomes (ORs of 4.08 and 4.01, respectively). On face value, these are clinically impactful results.…”

“…Charlie W Lees , 1,2 Peter M Irving , 3,4 Laurent Beaugerie 5 The COVID-19 pandemic has raised questions about the management of people with inflammatory bowel disease (IBD). 1 To date, there have been over 43 million confirmed cases of COVID-19 globally, including over 1.1 million deaths (https:// COVID-19.…”

SARS-CoV-2 Virus Manifestations in the Gastrointestinal Tract: Therapeutic Implications

“…Also, mesalamine and sulfasalazine, as well as the combination of TNF-α with thiopurines, showed a worse outcome for COVID-19. Anti-TNF-α antibodies, anti-interleukin-12 (IL-12)/IL-23 antibodies, and integrin antagonists seem to be safe in the context of COVID-19 [ 25 , 26 ].…”