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. 2020 Aug;159(2):481-491.e3.
doi: 10.1053/j.gastro.2020.05.032. Epub 2020 May 18.

Corticosteroids, But Not TNF Antagonists, Are Associated With Adverse COVID-19 Outcomes in Patients With Inflammatory Bowel Diseases: Results From an International Registry

Erica J Brenner  1 , Ryan C Ungaro  2 , Richard B Gearry  3 , Gilaad G Kaplan  4 , Michele Kissous-Hunt  5 , James D Lewis  6 , Siew C Ng  7 , Jean-Francois Rahier  8 , Walter Reinisch  9 , Frank M Ruemmele  10 , Flavio Steinwurz  11 , Fox E Underwood  4 , Xian Zhang  12 , Jean-Frederic Colombel  13 , Michael D Kappelman  14
Affiliations

Corticosteroids, But Not TNF Antagonists, Are Associated With Adverse COVID-19 Outcomes in Patients With Inflammatory Bowel Diseases: Results From an International Registry

Erica J Brenner et al. Gastroenterology. 2020 Aug.

Abstract

Background and aims: The impact of Coronavirus disease 2019 (COVID-19) on patients with inflammatory bowel disease (IBD) is unknown. We sought to characterize the clinical course of COVID-19 among patients with IBD and evaluate the association among demographics, clinical characteristics, and immunosuppressant treatments on COVID-19 outcomes.

Methods: Surveillance Epidemiology of Coronavirus Under Research Exclusion for Inflammatory Bowel Disease (SECURE-IBD) is a large, international registry created to monitor outcomes of patients with IBD with confirmed COVID-19. We calculated age-standardized mortality ratios and used multivariable logistic regression to identify factors associated with severe COVID-19, defined as intensive care unit admission, ventilator use, and/or death.

Results: 525 cases from 33 countries were reported (median age 43 years, 53% men). Thirty-seven patients (7%) had severe COVID-19, 161 (31%) were hospitalized, and 16 patients died (3% case fatality rate). Standardized mortality ratios for patients with IBD were 1.8 (95% confidence interval [CI], 0.9-2.6), 1.5 (95% CI, 0.7-2.2), and 1.7 (95% CI, 0.9-2.5) relative to data from China, Italy, and the United States, respectively. Risk factors for severe COVID-19 among patients with IBD included increasing age (adjusted odds ratio [aOR], 1.04; 95% CI, 1.01-1.02), ≥2 comorbidities (aOR, 2.9; 95% CI, 1.1-7.8), systemic corticosteroids (aOR, 6.9; 95% CI, 2.3-20.5), and sulfasalazine or 5-aminosalicylate use (aOR, 3.1; 95% CI, 1.3-7.7). Tumor necrosis factor antagonist treatment was not associated with severe COVID-19 (aOR, 0.9; 95% CI, 0.4-2.2).

Conclusions: Increasing age, comorbidities, and corticosteroids are associated with severe COVID-19 among patients with IBD, although a causal relationship cannot be definitively established. Notably, tumor necrosis factor antagonists do not appear to be associated with severe COVID-19.

Keywords: COVID-19; Crohn’s Disease; Inflammatory Bowel Disease; Ulcerative Colitis.

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Figures

Figure 1
Figure 1
World map depicting cases of COVID-19 among patients with IBD reported to the SECURE-IBD database. Interactive web-based map: http://covidibd.org/map/
Figure 2
Figure 2
US map depicting cases of COVID-19 among patients with IBD reported to the SECURE-IBD database. Interactive web-based map: http://covidibd.org/map/
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