Hospitalisation for Drug Infusion Did Not Increase Levels of Anxiety and the Risk of Disease Relapse in Patients with Inflammatory Bowel Disease during COVID-19 Outbreak

Abstract

During the coronavirus disease 2019 (COVID-19) pandemic, immunomodulatory therapies and hospital admission were suspected to increase the risk of infection. Nevertheless, patients with inflammatory bowel diseases (IBD) treated with intravenous (i.v.) biologics had to move to hospitals for drug infusion. We investigated the impact of hospitalisation in patients with IBD. We conducted a survey including consecutive IBD patients initially in clinical and biochemical remission treated with biologics at the end of the first lockdown period. Patients underwent the normally scheduled clinical visits, performed at hospital for i.v.-treated patients or at home for patients treated with s.c. drugs. We administered to all patients the Hospital Anxiety and Depression Scale (HADS) questionnaire and other 12 questions, specifically related to COVID-19 and its implications. A total of 189 IBD patients were recruited, 112 (59.3%) treated with i.v. drugs and 77 (40.7%) with s.c. ones. No relapses were recorded in either group (hospitalized vs. non-hospitalized, p = ns), as well as which, COVID-19 infections were not demonstrated in patients in contact with people with suspected symptoms or directly experiencing them. The total HADS score obtained by the sum of all items was also almost identical between groups (37.1 ± 2.8 vs. 37.2 ± 2.8; p = 0.98). In patients treated with i.v. drugs receiving a televisit (n = 17), the rate of satisfaction with telemedicine (58.8%) was significantly lower compared with those treated with s.c. drugs (94.8%; p < 0.0005). Our results suggest that hospitalisation during the COVID-19 outbreak does not increase the risk of COVID-19 infection as well as the risk of IBD relapse; moreover, the similar levels of anxiety in both groups could confirm that there is no need to convert patients from i.v. to s.c. therapy.

Recent advances in clinical practice: management of inflammatory bowel disease during the COVID-19 pandemic

“…At the beginning of the pandemic, patients and healthcare providers raised concerns related to risk of nosocomial SARS-CoV-2 infection when attending hospital for maintenance biological therapy and the impact of attendance on healthcare resources 83. Switching between biologicals, for example, from intravenous infliximab to subcutaneous adalimumab was not recommended by most guidelines targeting patients with IBD76 78 unlike those targeting patients with rheumatological conditions 84 85.…”

“…At the beginning of the pandemic, patients and healthcare providers raised concerns related to risk of nosocomial SARS-CoV-2 infection when attending hospital for maintenance biological therapy and the impact of attendance on healthcare resources. 83 Switching between biologicals, for example, from intravenous infliximab to subcutaneous adalimumab was not recommended by most guidelines targeting patients with IBD 76 78 unlike those targeting patients with rheumatological conditions. 84 85 This is, in part, because recapture of disease remission with a second biological agent, following established remission with a first biological agent, is less durable and more likely to be associated with development of anti-drug antibodies thereby limiting future therapeutic options in IBD.…”