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

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Abstract

Objective

We sought to evaluate COVID-19 clinical course in patients with IBD treated with different medication classes and combinations.

Design

Surveillance 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.

Results

1439 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).

Conclusion

Combination 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

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Most cited references 30

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Clinical Characteristics of Coronavirus Disease 2019 in China

Wei-jie Guan, Zheng-yi Ni, Yu Hu … (2020)

Abstract Background Since December 2019, when coronavirus disease 2019 (Covid-19) emerged in Wuhan city and rapidly spread throughout China, data have been needed on the clinical characteristics of the affected patients. Methods We extracted data regarding 1099 patients with laboratory-confirmed Covid-19 from 552 hospitals in 30 provinces, autonomous regions, and municipalities in mainland China through January 29, 2020. The primary composite end point was admission to an intensive care unit (ICU), the use of mechanical ventilation, or death. Results The median age of the patients was 47 years; 41.9% of the patients were female. The primary composite end point occurred in 67 patients (6.1%), including 5.0% who were admitted to the ICU, 2.3% who underwent invasive mechanical ventilation, and 1.4% who died. Only 1.9% of the patients had a history of direct contact with wildlife. Among nonresidents of Wuhan, 72.3% had contact with residents of Wuhan, including 31.3% who had visited the city. The most common symptoms were fever (43.8% on admission and 88.7% during hospitalization) and cough (67.8%). Diarrhea was uncommon (3.8%). The median incubation period was 4 days (interquartile range, 2 to 7). On admission, ground-glass opacity was the most common radiologic finding on chest computed tomography (CT) (56.4%). No radiographic or CT abnormality was found in 157 of 877 patients (17.9%) with nonsevere disease and in 5 of 173 patients (2.9%) with severe disease. Lymphocytopenia was present in 83.2% of the patients on admission. Conclusions During the first 2 months of the current outbreak, Covid-19 spread rapidly throughout China and caused varying degrees of illness. Patients often presented without fever, and many did not have abnormal radiologic findings. (Funded by the National Health Commission of China and others.)

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Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention

Zunyou Wu, Jennifer M. McGoogan (2020)

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Risk Factors Associated With Acute Respiratory Distress Syndrome and Death in Patients With Coronavirus Disease 2019 Pneumonia in Wuhan, China

Chaomin Wu, Xiaoyan Chen, Yanping Cai … (2020)

Coronavirus disease 2019 (COVID-19) is an emerging infectious disease that was first reported in Wuhan, China, and has subsequently spread worldwide. Risk factors for the clinical outcomes of COVID-19 pneumonia have not yet been well delineated.

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Author and article information

Journal

Journal ID (nlm-ta): Gut

Journal ID (iso-abbrev): Gut

Journal ID (hwp): gutjnl

Journal ID (publisher-id): gut

Title: Gut

Publisher: BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )

ISSN (Print): 0017-5749

ISSN (Electronic): 1468-3288

Publication date (Print): April 2021

Publication date (Electronic): 20 October 2020

Volume: 70

Issue: 4

Pages: 725-732

Affiliations

[1 ]departmentThe Henry D Janowitz Division of Gastroenterology , Icahn School of Medicine at Mount Sinai , New York, New York, USA

[2 ]University of North Carolina at Chapel Hill , Chapel Hill, North Carolina, USA

[3 ]departmentDepartment of Medicine , University of Otago , Christchurch, New Zealand

[4 ]departmentDepartments of Medicine and Community Health Sciences , University of Calgary , Calgary, Alberta, Canada

[5 ]Fifth Ave GI , New York, New York, USA

[6 ]departmentDivision of Gastroenterology , Hospital of the University of Pennsylvania , Philadelphia, Pennsylvania, USA

[7 ]departmentDepartment of Medicine and Therapeutics, Institute of Digestive Disease, State Key Laboratory of Digestive Disease, Li Ka Shing Institute of Health Science , Chinese University of Hong Kong , Shatin, NT, Hong Kong

[8 ]departmentDepartment of Gastroenterology , Université Catholique de Louvain , Yvoir, Belgium

[9 ]departmentDepartment of Medicine IV , Medical University Vienna , Vienna, Austria

[10 ]departmentDepartment of Gastroenterology , Hospital Israelita Albert Einstein , Sao Paulo, Brazil

Author notes

[Correspondence to ] Dr Ryan C Ungaro, The Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; ryan.ungaro@ 123456mssm.edu

Author information

Ryan C Ungaro http://orcid.org/0000-0001-8687-3758

Gilaad G Kaplan http://orcid.org/0000-0003-2719-0556

Siew C Ng http://orcid.org/0000-0002-6850-4454

Walter Reinisch http://orcid.org/0000-0002-2088-091X

Article

Publisher ID: gutjnl-2020-322539

DOI: 10.1136/gutjnl-2020-322539

PMC ID: 8136807

PubMed ID: 33082265

SO-VID: 91738ab2-98ae-4bf1-bcb3-1470b6b62ba6

License:

This article is made freely available for use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.

History

Date received : 15 July 2020

Date revision received : 28 September 2020

Date accepted : 29 September 2020

Funding

Funded by: FundRef http://dx.doi.org/10.13039/100000002, National Institutes of Health;

Award ID: UL1TR002489

Funded by: FundRef http://dx.doi.org/10.13039/100007028, Leona M. and Harry B. Helmsley Charitable Trust;

Award ID: 2003-04445

Funded by: FundRef http://dx.doi.org/10.13039/100000062, National Institute of Diabetes and Digestive and Kidney Diseases;

Award ID: K23KD111995-01A1

Custom metadata

access-type free

ScienceOpen disciplines: Gastroenterology & Hepatology

Keywords: inflammatory bowel disease,infectious disease

Data availability:

ScienceOpen disciplines: Gastroenterology & Hepatology

Keywords: inflammatory bowel disease, infectious disease

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