Final Analysis of COVID-19 Patients With Inflammatory Bowel Disease in Japan (J-COSMOS): A Multicenter Registry Cohort Study

Abstract

Background and aims: Japan has experienced 8 waves of the coronavirus disease 2019 (COVID-19) outbreak over the past 3 years, resulting in an increasing number of deaths and incidence of severe infections. This study aimed to analyze the data from the Japanese inflammatory bowel disease (IBD) patients with COVID-19 registry (J-COSMOS) up to the eighth wave to investigate the clinical course of IBD patients with COVID-19 and factors contributing to disease severity.

Methods: In this multicenter, observational, cohort study, we analyzed a cohort of 1308 IBD patients diagnosed with COVID-19, enrolled across 77 participating facilities in the J-COSMOS registry from June 2020 to December 2022. Data on age, sex, IBD (classification, treatment, and activity), and COVID-19 (symptoms, severity, and treatment) were analyzed.

Results: The majority of patients (76%) were in clinical remission. According to the World Health Organization classification of COVID-19 severity, 98.4% of IBD patients had nonsevere disease, while 1.6% of patients had severe or critical disease. COVID-19 did not affect disease activity in most IBD patients. Stepwise logistic regression analysis revealed that high body mass index, and cerebrovascular disease were risk factors for severe COVID-19. Corticosteroids could affect COVID-19 severity, whereas anti-tumor necrosis factor α antibodies and thiopurines were associated with a reduced risk of severe COVID-19. No deaths were observed among IBD patients with COVID-19 registered in this cohort.

Conclusion: The impact of COVID-19 on IBD disease activity and factors associated with COVID-19 severity were consistent with findings of previous reports. No deaths in Japanese patients with IBD were observed.

Keywords: Body Mass Index; Cerebrovascular Disease; Corticosteroids; SARS-CoV-2.

Graphical abstract

Figure 1

(A) Age distribution of Japanese IBD patients with COVID-19 (B) Transition of the number of Japanese IBD patients with COVID-19.

Figure 2

(A) Proportion of patient who have discontinued each IBD therapy; (B) Left figure; of the 312 patients receiving both 5-ASA and thiopurines, 95 patients (30.4%) discontinued any of the drugs. Proportion of these patients receiving both 5-ASA and thiopurines who have discontinued either, or both. 5-ASA only: 0% of patients discontinued 5-ASA alone, thiopurines only: 86.3% of patients discontinued thiopurines alone, both: 13.7% of patients discontinued both. Right figure; of the 317 patients receiving both anti-TNFα antibodies and thiopurines, 77 patients (24.3%) discontinued any of the drugs. Proportion of these patients receiving both anti-TNFα antibodies and thiopurines who discontinued either or both. anti-TNFs: 5.2% of patients have discontinued anti-TNFα antibodies alone, thiopurines only: 92.2% of patients discontinued thiopurines alone, both: 2.6% of patients discontinued both. 5-ASA, 5-aminosalicylic acid.

Figure 3

Alluvial diagram of change in disease activity: (A) changes in pMayo score before, during, and after COVID-19 (B) changes in HBI score before, during, and after COVID-19 (A and B).