Treatment adaptations and outcomes of patients experiencing inflammatory bowel disease flares during the early COVID‐19 pandemic: the PREPARE‐IBD multicentre cohort study

Abstract

Summary Background The COVID‐19 pandemic offered a unique opportunity to understand inflammatory bowel disease (IBD) management during unexpected disruption. This could help to guide practice overall. Aims To compare prescribing behaviour for IBD flares and outcomes during the early pandemic with pre‐pandemic findings Methods We performed an observational cohort study comprising patients who contacted IBD teams for symptomatic flares between March and June 2020 in 60 National Health Service trusts in the United Kingdom. Data were compared with a pre‐pandemic cohort after propensity‐matching for age and physician global assessment of disease activity. Results We included 1864 patients in each of the pandemic and pre‐pandemic cohorts. The principal findings were reduced systemic corticosteroid prescription during the pandemic in Crohn's disease (prednisolone: pandemic 26.5% vs. 37.1%; p < 0.001) and ulcerative colitis (UC) (prednisolone: pandemic 33.5% vs. 40.7%, p < 0.001), with increases in poorly bioavailable oral corticosteroids in Crohn's (pandemic 15.6% vs. 6.8%; p < 0.001) and UC (pandemic 11.8% vs. 5.2%; p < 0.001). Ustekinumab (Crohn's and UC) and vedolizumab (UC) treatment also significantly increased. Three‐month steroid‐free remission in each period was similar in Crohn's (pandemic 28.4% vs. 32.1%; p = 0.17) and UC (pandemic 36.4% vs. 40.2%; p = 0.095). Patients experiencing a flare and suspected COVID‐19 were more likely to have moderately‐to‐severely active disease at 3 months than those with a flare alone. Conclusions Despite treatment adaptations during the pandemic, steroid‐free outcomes were comparable with pre‐pandemic levels, although concurrent flare and suspected COVID‐19 caused worse outcomes. These findings have implications for IBD management during future pandemics and for standard practice.

SARS-CoV-2 vaccination in inflammatory bowel disease patients is not associated with flares: a retrospective single-centre Swiss study

“…Furthermore, the question of inducing flares through vaccine-triggered immune activation arose, even though it has never been recorded for routinely administrated vaccines [ 12 , 19–22 ]. SARS-CoV-2 infections were identified as possible IBD flare inducers, further increasing the fear of SARS-CoV-2 vaccination–induced flares [ 5 , 23 ]. Eighty percent of hesitant IBD patients reported that their health care provider’s recommendation was important in their decision [ 13 ].…”

Editorial: the impact of COVID on the management of IBD flares: different care but similar outcomes—authors' reply

“…We thank Haydek and Scott for their thoughtful editorial about our PREPARE‐IBD study 1,2 . As they highlighted, there were reassuring signals regarding clinical outcomes during the pandemic despite the significant challenges faced by clinical teams.…”

“…We thank Haydek and Scott for their thoughtful editorial about our PREPARE‐IBD study. 1 , 2 As they highlighted, there were reassuring signals regarding clinical outcomes during the pandemic despite the significant challenges faced by clinical teams. This suggests that further evaluation of the adaptations made in diagnostic, monitoring and treatment approaches will be useful, both as we learn to live with SARS‐CoV‐2 and in anticipation of future pandemics.…”

Editorial: the impact of COVID on management of IBD flares—different care but similar outcomes

“…Saifuddin et al 3 performed a retrospective observational cohort study evaluating 1864 patients with IBD from 60 UK National Health Service trusts who self‐reported IBD‐related symptoms during the first 4 months of the COVID pandemic compared to patients reporting symptoms prior to the pandemic. Prescribing and monitoring patterns were assessed, as were 3‐month outcomes including steroid‐free remission, hospital admission and management of flares.…”