Benjamin Click, MD: The COVID-19 Impact on the TARGET-IBD Study

Benjamin Click, MD

The real world implications of the coronavirus disease 2019 (COVID-19) is having on inflammatory bowel disease (IBD) patients will be included in the data of an ongoing, expansive, registry-based cohort study.

In an interview with HCPLive®, Benjamin Click, MD, a staff gastroenterologist with the Cleveland Clinic, explained how TARGET-IBD, a longitudinal cohort study examining IBD patients receiving usual care at community and academic practices in the US, will incorporate information learned from the COVID-19 pandemic.

HCPLive: Has COVID-19 changed how you are conducting the study?

Click: So, I think, generally speaking, COVID-19 has had a large impact on research conduct throughout the country and globally. Many studies have been put on hold while evaluating how to deal with COVID’s impact on research. And so, a lot of studies have been paused temporarily. TARGET-IBD, fortunately, has a real world perspective registry component that has not been paused, at least at our sites.

We continued enrolling patients because TARGET-IBD is a standard of care registry, meaning that patients aren't brought for research visits or procedures. This study has continued and we will obtain the data on how practice patterns have varied during COVID-19 and the impact or potential impact of COVID-19 on IBD outcomes during this time period.

HCPLive: How has COVID-19 impacted IBD patients in general?

Click: The impact of COVID-19 on inflammatory bowel disease is going to be multi-faceted and We're going to be various phases of impact.

In the first phase, the management of inflammatory bowel disease and medications during the active pandemic period is going to be critical.

In the second phase, we are going to see patients who have delayed care during the first phase potentially experiencing complications in their disease and coming in for the care.

And then in the third phase there will be even more involved in terms of the potential impact related to deferrals of elective screening procedures or management of chronic diseases and I think in inflammatory bowel disease we are going to see impacts in all of these.

Certainly, this is a trying time for our patients and providers. While all of us figure out how to deal with COVID-19, the healthcare industry and system has been faced with a monumental challenge and rapid pivot to virtual and digital healthcare delivery, which I think many centers and providers have managed exceptionally well.

There are clear impact on the mental health and stress and anxiety related to caring for chronic diseases during such an unprecedented in our lifetime pandemic. And so, making sure that patients and providers identify these impacts on stress and anxiety levels and manage accordingly is an important potentially unmet need that we're facing currently.

HCPLive: It has long thought that some gastrointestinal symptoms can be early warning signs of a COVID-19 infection. Do you believe this closer look at IBD patients will impact the TARGET study and maybe lead you in a certain direction you may not have taken if it weren’t for the global pandemic?

Click: Obviously, we're still learning a lot about the impact of the SARS-CoV-2 pandemic and its impact specifically in inflammatory bowel disease patients. And so, we're still collecting a lot of information and learning very rapidly what information we can disseminate and share with our colleagues and our patient population.

What we do know is that patients who stopped their medications for Crohn's disease and ulcerative colitis are at a high risk for disease flare and complications related to that disease.

When weighing the risks and benefits withholding therapies, the current recommendation statements from various societies uniformly recommend that IBD patients stay on their medications to avoid that risk of flare and complications related to the disease itself.

What we're starting to understand with the aggregation and sharing of information and experiences is potentially identifying signals that may put individuals at higher risk.

There's some recent data emerging related to steroid use and steroids are typically used for active disease. This further strengthens the recommendation that patients stay on their IBD medications to control the disease, prevent flares, potential corticosteroid requirements, and the risks imposed by the steroid use regarding COVID-19 complication, but certainly it's still an evolving process.