Corticosteroids, TNF Antagonists and Outcomes from COVID-19 with IBD

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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, study was carried out. 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. Calculation of the age/standardized mortality ratios was carried out using multivariable logistic regression to identify factors associated with severe COVID-19, defined as intensive care unit admission, ventilator use and/or death.

A total of 525 cases from 33 countries were reported (median age 43 years, 53% men); 37 patients 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, 1.5, and 1.7, relative to data from China, Italy and the United States, respectively. Risk factors for severe COVID-19 among patients with IBD included increased age (AOR 1.04), greater than 2 comorbidities (AOR 2.9), systemic corticosteroids (AOR 6.9), and sulfasalazine or 5-aminosalicylate use (AOR 3.1). Tumor necrosis factor antagonist treatment was not associated with severe COVID-19 (AOR 0.9).

It was concluded that increasing age, comorbidities and corticosteroids are associated with severe COVID-19 among patients with IBD, although a causal relationship cannot be definitively established. Notably, TNF antagonists do not appear to be associated with severe COVID-19.

Brenner, E., Ungaro, R., Gearry, R., et al. “Corticosteroids, But Not TNF Antagonists are Associated with Adverse COVID-19 Outcomes in Patients with Inflammatory Bowel Diseases: Results from an International Registry.” Gastroenterology 2020; Vol. 159, pp. 481-491.

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