Certain IBD meds tied to excess risk of COVID-19 hospitalization

While there are no differences in COVID-19-related outcomes in patients with inflammatory bowel disease (IBD) between those in remission vs those who are not, being on medications such as corticosteroids and aminosalicylates may put them at higher risk of hospitalization, suggest studies presented at AIBD 2021.

Compared with IBD patients in remission, those not in remission were not worse off in terms of COVID-19-related outcomes such as need for hospitalization, use of therapy for COVID-19 such as monoclonal antibodies, ICU stay, and death (p>0.05). [AIBD 2021, abstract P026]

“Our study suggests minimal impact of COVID-19 on IBD-related outcomes in patients in remission,” said presenting author Dr Spandorfer Adam from Emory University School of Medicine in Atlanta, Georgia, US.

“Patients who were not in remission did have worse IBD related outcomes compared to those in remission,” he noted.

Patients not in remission tended to escalate immunosuppressive maintenance therapy more commonly than those in remission (44.4 percent vs 6.7 percent; p=0.0015). They were also more likely to require hospitalization or surgery due to IBD compared with those in remission (18.5 percent vs 0.0 percent; p=0.02).

“[Nonetheless,] the findings could reflect the natural history of IBD-related disease rather than being related to COVID-19,” Adam explained.

Participants in the retrospective case series study were 57 patients with IBD who were diagnosed with COVID-19 in a tertiary care referral centre. The researchers compared IBD-related and COVID-19-related outcomes in patients who were in stable remission prior to COVID-19 diagnosis (52.6 percent) vs those who were not in remission.

Impact of IBD medications

“Current evidence suggests that patients with IBD do not have an increased risk of infection of SARS-CoV-2 or the development of COVID-19 complications …. [but] the effect of immunosuppressant medications on the severity of COVID-19 disease [is] still unclear,” said researchers of another study.

In an online survey by the Brazilian IBD Study Group, researchers looked at the role of various IBD therapies on COVID-19 outcomes in 74 respondents with IBD (mean age 37.67 years, 32.9 percent male, 72.6 percent with Crohn’s disease). [AIBD 2021, abstract P059]

The most common treatment used was biologics, reported in 67.7 percent of patients — with TNF-antagonist being the most common class of biologics (72.0 percent). Among these, 34 percent were used in combination with immunomodulators.

Immunomodulators, in turn, were the second most commonly used IBD therapy (37.8 percent), followed by aminosalicylates and corticosteroids (31.1 percent and 28.4 percent, respectively).

Overall, half of the patients visited the emergency department and 17.6 percent of them were hospitalized.

Patients who required hospitalization were significantly more likely to be on aminosalicylates (61.5 percent vs 24.6 percent; p=0.009) and corticosteroids (61.5 percent vs 21.3 percent; p=0.003) than non-hospitalized patients. On the other hand, there were no significant differences seen for biologics or immunomodulators.

In addition, hospitalized patients were also more likely to have prolonged COVID-19 symptoms (20 vs 10 days; p=0.0001) and COVID-19-related gastrointestinal symptoms (100 percent vs 42.6 percent; p<0.001).

“Corticosteroids, aminosalicylates, prolonged COVID-19 symptoms and gastrointestinal symptoms related to COVID-19 are associated with the need of hospitalization in IBD patients with COVID-19,” the researchers concluded.