IBD Treatment Doesn’t Lead to Severe COVID-19 Outcomes

While it was a concern at the beginning of the COVID-19 pandemic, new research shows inflammatory bowel disease (IBD) are not at an increased risk of adverse outcomes regardless of which type of medication they are treated with.

A team, led by Antoine Meyer, EPIPHARE, Épidémiologie des produits de santé, ANSM-CNAM, compared the risk of severe COVID-19 adverse events based on IBD medications in a large and unselected population.

In the SECURE-IBD study, which was based on a physician-reported registry, shows thiopurines, either alone or combined with anti-TNF therapies, could increase the risk of severe COVID-19 outcomes.

“Immunomodulators and biologics prescribed in patients with IBD do not appear to increase the severity of COVID-19 infection,” the authors wrote.

Hypothesis During the COVID-19 Pandemic

At the beginning of the 2020, 73.7% of IBD patients were unexposed to treatments, while 19.7% were exposed to biologics and 9.1% were exposed to immunomodulators.

Since the beginning of the pandemic it was believed that IBD patients may be at an enhanced risk for adverse events due to immunotherapy treatments.

However, current recommendations state that IBD medications should not be discontinued, to avoid hospitalization during the pandemic.

New Data

The researchers used data from the French national health data system to identify the risks of hospitalizations and of death or mechanical ventilation for COVID-19 between February 15, 2020 and August 31, 2020 in IBD patients.

In the study, the investigators used multivariable Cox models adjusted for socio-demographic characteristics, budesonide/corticosteroids, and aminosalicylates use, and comorbidities in IBD patients according to IBD treatment—immunomodulators and biologics.

The cohort included a total of 268,185 IBD patients, of which 600 were hospitalized for COVID-19 and 111 individuals who died or were mechanically ventilated (78 deaths).

Using a multivariable analysis, the team found the risk of hospitalization for COVID-19 did not differ based on IBD treatment category (immunomodulatory monotherapy: aHR of unexposed patients, 0.94; 95% CI, 0.66-1.35; anti-TNF monotherapy: aHR,1.05; 95% CI, 0.80-1.38; anti-TNF combination therapy: aHR, 0.80; 95% CI, 0.38-1.69; vedolizumab: aHR, 1.06; 95% CI, 0.55-2.05; ustekinumab: aHR, 1.25; 95% CI, 0.64-2.43).

The risk of death or mechanical ventilation for COVID-19 was also similar according to IBD treatment.

Conclusion and Limitations

“In conclusion, in patients with IBD, the risk of severe COVID-19 does not appear to differ according to IBD treatment,” the authors wrote. “Therefore, IBD medications, except corticosteroids, should be maintained during the pandemic, to limit the risk of IBD relapse in the context of healthcare system overload.”

There was some limitations found in the study. One potential limitation was IBD patients and COVID-19 outcomes were based on algorithms rather than clinical data. In addition, some patients may have stopped treatment after the epidemic onset due to fear of having COVID-19. This resulted in exposure misclassification.

Finally, the limited number of deaths and mechanical ventilation with thiopurines and biologics, the investigators cannot exclude minor differences between the different treatment groups.

The study, “Risk of severe COVID-19 in patients treated with IBD medications: a French nationwide study,” was published online in Alimentary Pharmacology & Therapeutics.