IBD Treatments do not Raise Risk of COVID-19 Hospitalization

Various treatments for inflammatory bowel disease (IBD), including biologics, do not increase the risk of COVID-19-related hospitalizations, according to new research.

A team, led by Fatema Alrashed, Department of Pharmacy Practice, Kuwait University, assessed the link between the risk of COVID-19-related hospitialization and various treatments for IBD, including biologics and small molecule compounds.

The Treatments

Biologics and small molecule compound medications often used to treat IBD are concerning for patients in recent years due to the risk of contracting COVID-19. In addition, since the beginning of the COVID-19 pandemic there has been a fear that immunocomprised individuals are at an increased risk of severe outcomes.

In the systematic review and meta-analysis, the investigators identified studies that reported COVID-19-related hospitilzization for patients with IBD receiving biologic therapies or tofacitinib between December 2019 and September 2021. Overall, they included 18 studies in the final analysis from the initiall 811 studies identified. The studies were based in the US (n = 6), Italy (n = 5), the UK (n =3), France, Spain, and Denmark.

The Studies

Included were all relavent randomized controlled trials, observational studies, and letters to the editor, as well as data from the SECURE-IBD database. The investigators only used data from adult patients with IBD and confirmed SARS-CoV-2 infections.

They also sought studies with reported hospitalization data in patients with IBD infected with SARS-CoV-2, who received biologic therapies, including adalimumab, infliximab, vedolizumab, and ustekinumab or small-molecule janus kinase inihibitors.

The investigators sought primary outcomes of the risk of COVID-19-related hospitilation in patients taking biologic therapy or small-molecule JAK inhibitors.

The Risk

The relative risk of hospitalization was substantially lower for patients with IBD and COVID-19 who were treated with biologics (RR, 0.47; 95% CI, 0.42-0.52; P <.00001) compared to patients not treated with biologics.

The relative risk was also lower in patients receiving anti-tumor necrosis factors (TNFs) compared to patients who were not (RR, 0.48; 95% CI, 0.41-0.55; P <0.00001).

Similarily, patients treated with ustekinumab also had a lower relative risk (RR, 0.55; 95% CI, 0.43-0.72; P <0.00001).

The investigators also learned that combination therapy that included anti-TNF and an immunomodulator did not lower the overall risk of COVID-19-related hospitalization (RR, 0.98; 95% CI, 0.82-1.18; P = 0.84).

On the other hand, vedolizumab (RR, 1.13; 95% CI, 0.75-1.73; P = 0.56) and tofacitinib (RR, 0.81; 95% CI, 0.49-1.33; P = 0.40) were not associated with a lower risk of COVID-19-related hospitilzation.

“Regarding COVID-19-related hospitalization in IBD, anti-TNFs and ustekinumab were associated with decreased risk of hospitalization. In addition, vedolizumab and tofacitinib were not associated with COVID-19-related hospitalization,” the authors wrote.

The study, “Impact of biologics and small molecules for inflammatory bowel disease on COVID-19-related hospitalization and mortality: A systematic review and meta-analysis,” was published online in JGH Open.