Lower incidence of COVID‐19 in patients with inflammatory bowel disease treated with non‐gut selective biologic therapy

Ardizzone, Sandro; Ferretti, Francesca; Monico, Maria Camilla; Gabrielli, Anna Maria Carvalhas; Carmagnola, S.; Bezzio, Cristina; Saibeni, Simone; Bosani, M.; Caprioli, Flavio; Mazza, Stefano; Casini, Valentina; Cortelezzi, C.C.; Parravicini, M.; Cassinotti, A.; Cosimo, Paola; Indriolo, A.; Sabatino, Antonio Di; Lenti, Marco Vincenzo; Pastorelli, Luca; Conforti, Francesco; Ricci, Chiara; Sarzi‐Puttini, Piercarlo; Vecchi, Maurizio; Maconi, Giovanni

doi:10.1111/jgh.15591

Cited by 19 publications

(20 citation statements)

References 27 publications

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“…Moreover, in a retrospective multicenter study of IBD patients under biologics, non-gut-selective agents were associated with a lower incidence of COVID-19 infection and related symptoms compared with the patients on nonbiologic therapies (7.5% versus 18%, p < 0.001). Compared with the general population, IBD patients on biologic therapy are not exposed to a higher risk of COVID-19 [ 32 ]. A recent study showed that patients with COVID-19 infection who developed autoantibodies had higher severe COVID-19 outcomes [ 33 , 34 ].…”

Section: Discussionmentioning

confidence: 99%

Clinical Outcomes of COVID-19 and Impact on Disease Course in Patients with Inflammatory Bowel Disease

Wetwittayakhlang

Albader

Golovics

et al. 2021

Canadian Journal of Gastroenterology and Hepatology

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Background and Aims. The impact of COVID-19 has been of great concern in patients with inflammatory bowel disease (IBD) worldwide, including an increased risk of severe outcomes and/or possible flare of IBD. This study aims to evaluate prevalence, outcomes, the impact of COVID-19 in patients with IBD, and risk factors associated with severe COVID-19 or flare of IBD activity. Methods. A consecutive cohort of IBD patients who were diagnosed with COVID-19 infection and followed up at the McGill University Health Care Centre was obtained between March 1, 2020, and April 30, 2021. Demographics, comorbidities, IBD (type, treatments, pre- and post-COVID-19 clinical activity, biomarkers, and endoscopic activity), and COVID-19-related outcomes (pneumonia, hospitalization, death, and flare of IBD disease) were analyzed. Results. A cohort of 3,516 IBD patients was included. 82 patients (2.3%) were diagnosed with COVID-19 infection (median age: 39.0 (IQR 27.8–48.0), 77% with Crohn’s disease, 50% were female). The prevalence of COVID-19 infection in IBD patients was significantly lower compared to the general population in Canada and Quebec (3.5% versus 4.3%, p < 0.001 ). Severe COVID-19 occurred in 6 patients (7.3%); 2 patients (2.4%) died. A flare of IBD post-COVID-19 infection was reported in 8 patients (9.8%) within 3 months. Biologic therapy was held during active COVID-19 infection in 37% of patients. Age ≥55 years (odds ratio (OR): 11.1, 95% CI: 1.8–68.0), systemic corticosteroid use (OR: 4.6, 95% CI: 0.7–30.1), active IBD (OR: 3.8, 95% CI: 0.7–20.8), and comorbidity (OR: 4.9, 95% CI: 0.8–28.6) were factors associated with severe COVID-19. After initial infection, 61% of IBD patients received COVID-19 vaccinations. Conclusion. The prevalence of COVID-19 infection among patients with IBD was lower than that in the general population in Canada. Severe COVID-19, mortality, and flare of IBD were relatively rare, while a large proportion of patients received COVID-19 vaccination. Older age, comorbidities, active IBD disease, and systemic corticosteroid, but not immunosuppressive or biological therapy, were associated with severe COVID-19 infection.

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Section: Discussionmentioning

confidence: 99%

Clinical Outcomes of COVID-19 and Impact on Disease Course in Patients with Inflammatory Bowel Disease

Wetwittayakhlang

Albader

Golovics

et al. 2021

Canadian Journal of Gastroenterology and Hepatology

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“…Some studies suggest that the risk of developing severe COVID-19 may be lower in biological-treated patients potentially due to the effect of these drugs in suppressing cytokine inflammatory pathways that underlie COVID-19-associated inflammatory complications 30 56 59. In one meta-analysis, pooled relative risks of hospitalisation (RR 0.34, 95% CI 0.19 to 0.61), ICU admission (RR 0.49, 95% CI 0.33 to 0.72) and mortality (RR 0.22, 95% CI 0.13 to 0.38) were lower in biological-treated patients, most of whom were on anti-TNF, compared with patients treated with other non-biologicals for IBD 30.…”

Section: Impact Of Ibd On Covid-19mentioning

confidence: 99%

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

Lin

Lau

Chanchlani

et al. 2022

Gut

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The COVID-19 pandemic has raised considerable concerns that patients with inflammatory bowel disease (IBD), particularly those treated with immunosuppressive therapies, may have an increased risk of SARS-CoV-2 acquisition, develop worse outcomes following COVID-19, and have suboptimal vaccine response compared with the general population. In this review, we summarise data on the risk of COVID-19 and associated outcomes, and latest guidance on SARS-CoV-2 vaccines in patients with IBD. Emerging evidence suggests that commonly used medications for IBD, such as corticosteroids but not biologicals, were associated with adverse outcomes to COVID-19. There has been no increased risk of de novo, or delayed, IBD diagnoses, however, an overall decrease in endoscopy procedures has led to a rise in the number of missed endoscopic-detected cancers during the pandemic. The impact of IBD medication on vaccine response has been a research priority recently. Data suggest that patients with IBD treated with antitumour necrosis factor (TNF) medications had attenuated humoral responses to SARS-CoV-2 vaccines, and more rapid antibody decay, compared with non-anti-TNF-treated patients. Reassuringly, rates of breakthrough infections and hospitalisations in all patients who received vaccines, irrespective of IBD treatment, remained low. International guidelines recommend that all patients with IBD treated with immunosuppressive therapies should receive, at any point during their treatment cycle, three primary doses of SARS-CoV-2 vaccines with a further booster dose as soon as possible. Future research should focus on our understanding of the rate of antibody decay in biological-treated patients, which patients require additional doses of SARS-CoV-2 vaccine, the long-term risks of COVID-19 on IBD disease course and activity, and the potential risk of long COVID-19 in patients with IBD.

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“…Indeed, evidence from a case series of patients with COVID-19 (but without IBD) has suggested that infliximab may help to combat severe COVID-19-induced cytokine storm syndrome by reducing systemic inflammation [ 83 ]. In addition, an observational study of Italian patients with IBD has reported that non-gut-selective agents (such as anti-TNF therapies) were associated with a lower incidence of SARS-CoV-2 infection, symptomatic COVID-19, and hospitalisations than were gut-selective biologics [ 88 ]. Consequently, there have been calls to investigate anti-TNF therapies as treatments for COVID-19 in clinical trials [ 89 ]: infliximab has recently been announced as one of three agents to be tested in hospitalised patients with COVID-19 in the World Health Organization’s Solidarity PLUS trial [ 90 ].…”

Section: Clinical Implications Of Sc Infliximab In the Covid-19 Pandemic Era And Beyondmentioning

confidence: 99%

Perspectives on Subcutaneous Infliximab for Rheumatic Diseases and Inflammatory Bowel Disease: Before, During, and After the COVID-19 Era

et al. 2022

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Graphical Abstract The coronavirus disease 2019 (COVID-19) pandemic has prompted significant changes in patient care in rheumatology and gastroenterology, with clinical guidance issued to manage ongoing therapy while minimising the risk of nosocomial infection for patients and healthcare professionals (HCPs). Subcutaneous (SC) formulations of biologics enable patients to self-administer treatments at home; however, switching between agents may be undesirable. CT-P13 SC is the first SC formulation of infliximab that received regulatory approval and may be termed a biobetter as it offers significant clinical advantages over intravenous (IV) infliximab, including improved pharmacokinetics and a convenient mode of delivery. Potential benefits in terms of reduced immunogenicity have also been suggested. With a new SC formulation, infliximab provides an additional option for dual formulation, which enables patients to transition from IV to SC administration route without changing agent. Before COVID-19, clinical trials supported the efficacy and safety of switching from IV to SC infliximab for patients with rheumatoid arthritis and inflammatory bowel disease (IBD), and SC infliximab may have been selected on the basis of patient and HCP preferences for SC agents. During the pandemic, patients with rheumatic diseases and IBD have successfully switched from IV to SC infliximab, with some clinical benefits and high levels of patient satisfaction. As patients switched to SC therapeutics, the reduction in resource requirements for IV infusion services may have been particularly welcome given the pandemic, facilitating reorganisation and redeployment in overstretched healthcare systems, alongside pharmacoeconomic benefits and a reduction in exposure to nosocomial infection. Telemedicine and contactless healthcare have been pushed to the forefront during the pandemic, and a lasting shift towards remote patient management and community/home-based drug administration is anticipated. SC infliximab supports the implementation of this paradigm for future improvements of healthcare value delivered. The accumulation of real-world data during the pandemic supports the high level of confidence, with patients, physicians, and healthcare systems benefitting from its uptake.

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Lower incidence of COVID‐19 in patients with inflammatory bowel disease treated with non‐gut selective biologic therapy

Cited by 19 publications

References 27 publications

Clinical Outcomes of COVID-19 and Impact on Disease Course in Patients with Inflammatory Bowel Disease

Clinical Outcomes of COVID-19 and Impact on Disease Course in Patients with Inflammatory Bowel Disease

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

Perspectives on Subcutaneous Infliximab for Rheumatic Diseases and Inflammatory Bowel Disease: Before, During, and After the COVID-19 Era

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