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. 2022 Feb 28;10(3):376.
doi: 10.3390/vaccines10030376.

COVID-19 in Patients with Inflammatory Bowel Disease: The Israeli Experience

Lev Lichtenstein  1 , Benjamin Koslowsky  2 , Ami Ben Ya'acov  2 , Irit Avni-Biron  3   4 , Baruch Ovadia  5 , Ofer Ben-Bassat  6 , Timna Naftali  4   7 , Uri Kopylov  4   8 , Yael Haberman  4   8 , Hagar Banai Eran  3   4 , Rami Eliakim  4   8 , Adi Lahat-Zok  4   8 , Ayal Hirsch  4   9 , Eran Zittan  10   11 , Nitsan Maharshak  4   9 , Matti Waterman  11   12 , Eran Israeli  4   13 , Idan Goren  3   4 , Jacob E Ollech  3   4 , Henit Yanai  3   4 , Bella Ungar  4   8 , Benjamin Avidan  4   8 , Dana Ben Hur  11   12 , Bernardo Melamud  4   13 , Ori Segol  14 , Zippora Shalem  4   15 , Iris Dotan  3   4 , Selwyn H Odes  4   16 , Shomron Ben-Horin  4   8 , Yf'at Snir  3   4 , Yael Milgrom  17 , Efrat Broide  4   15 , Eran Goldin  2 , Shmuel Delgado  18 , Yulia Ron  4   9 , Nathaniel Aviv Cohen  4   9 , Eran Maoz  1 , Maya Zborovsky  1 , Safwat Odeh  19 , Naim Abu Freha  20 , Eyal Shachar  4   8 , Yehuda Chowers  11   12 , Tal Engel  4   8 , Hila Reiss-Mintz  4   16 , Arie Segal  20 , Adar Zinger  17 , Ariella Bar-Gil Shitrit  2
Affiliations

COVID-19 in Patients with Inflammatory Bowel Disease: The Israeli Experience

Lev Lichtenstein et al. Vaccines (Basel). .

Abstract

Background: Crohn's disease (CD) and ulcerative colitis (UC) are chronic, immune-mediated inflammatory bowel diseases (IBD) affecting millions of people worldwide. IBD therapies, designed for continuous immune suppression, often render patients more susceptible to infections. The effect of the immune suppression on the risk of coronavirus disease-19 (COVID-19) is not fully determined yet.

Objective: To describe COVID-19 characteristics and outcomes and to evaluate the association between IBD phenotypes, infection outcomes and immunomodulatory therapies.

Methods: In this multi-center study, we prospectively followed IBD patients with proven COVID-19. De-identified data from medical charts were collected including age, gender, IBD type, IBD clinical activity, IBD treatments, comorbidities, symptoms and outcomes of COVID-19. A multivariable regression model was used to examine the effect of immunosuppressant drugs on the risk of infection by COVID-19 and the outcomes.

Results: Of 144 IBD patients, 104 (72%) were CD and 40 (28%) were UC. Mean age was 32.2 ± 12.6 years. No mortalities were reported. In total, 94 patients (65.3%) received biologic therapy. Of them, 51 (54%) at escalated doses, 10 (11%) in combination with immunomodulators and 9 (10%) with concomitant corticosteroids. Disease location, behavior and activity did not correlate with the severity of COVID-19. Biologics as monotherapy or with immunomodulators or corticosteroids were not associated with more severe infection. On the contrary, patients receiving biologics had significantly milder infection course (p = 0.001) and were less likely to be hospitalized (p = 0.001). Treatment was postponed in 34.7% of patients until recovery from COVID-19, without consequent exacerbation.

Conclusion: We did not witness aggravated COVID-19 outcomes in patients with IBD. Patients treated with biologics had a favorable outcome.

Keywords: COVID-19; Crohn’s disease; biological drugs; immune suppression; inflammatory bowel disease; ulcerative colitis.

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Conflict of interest statement

U.K. reports research support from Takeda, Janssen and Medtronic; speaker/advisory fees from AbbVie, Takeda, Janssen, M.S.D., Falk Pharma and Medtronic. R.E. reports consulting/speaker fees from AbbVie, Takeda, Janssen and Medtronic. E.Z. reports research support and consulting fees from Janssen, AbbVie, Takeda, Neopharm and Pfizer. N.M. reports research support from Takeda and Janssen; consulting fees from Janssen, Pfizer, Neopharm and BiomX; speaker fees from AbbVie, Pfizer and Takeda. M.W. reports consulting fees from AbbVie, Janssen, Takeda, Pfizer, Medtronic and Neopharm; speaker fees from AbbVie, Janssen and Takeda. H.Y. reports consulting/speaker fees from AbbVie, Janssen, Takeda, Pfizer, Falk Pharma, Neopharm and Given Imaging. I.D. reports research support from Pfizer and Altman Research; consulting/advisory fees from Takeda, Janssen, AbbVie, Celltrion, Arena Pharmaceuticals, Neopharm, Roche/Genentech, Pfizer, Medtronic, Gilead, Ferring, Rafa Laboratories, Given Imaging, M.S.D., Protalix and Sublimity Therapeutics; speaker/teaching fees from Takeda, Janssen, AbbVie, Ferring, Falk Pharma, Given Imaging, Roche/Genentech, Pfizer, Celltrion and M.S.D. S.B.-H. reports research support from Takeda, AbbVie, Celltrion, Pfizer and Janssen; consulting fees from Janssen, Takeda, AbbVie, Celltrion, SBH, GSK, Ferring and Pfizer. E.G. reports consulting fees from Janssen, Takeda, AbbVie and Digma Medical. YC reports grant support from AbbVie, Takeda, Janssen, Medtronic and Protalix; speaker fees from AbbVie, Takeda, Janssen and Ferring. A.B.-G.S. reports consulting/advisory fees from Takeda, Janssen, Neopharm, Pfizer and AbbVie; speaker/teaching fees from Takeda, Janssen, AbbVie, Neopharm and Rafa Laboratories; research support from Takeda and Janssen. The remaining authors have no conflicting interests to declare.

Figures

Figure 1
Figure 1
Association between IBD treatment and COVID-19 severity. (A) Number of IBD patients with various degrees of COVID-19 severity comparing biological therapy and non-biological therapy. (B) Outcome of COVID-19 in patients with IBD, comparing biological therapy and non-biological therapy. The p-value is based on a Pearson Chi-square test comparing patient distribution between groups (biological therapy and non-biological therapy), with p < 0.001 (***) in all degrees of COVID-19 severity and outcomes.
See this image and copyright information in PMC

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