Gastroenterology

Gastroenterology

Volume 159, Issue 2, August 2020, Pages 481-491.e3
Gastroenterology

Original Research
Full Report: Clinical—Alimentary Tract
Corticosteroids, But Not TNF Antagonists, Are Associated With Adverse COVID-19 Outcomes in Patients With Inflammatory Bowel Diseases: Results From an International Registry

https://doi.org/10.1053/j.gastro.2020.05.032Get rights and content

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

Inflammatory Bowel Disease
Crohn’s Disease
Ulcerative Colitis
COVID-19

Abbreviations used in this paper

aOR
adjusted odds ratio
CD
Crohn’s disease
CI
confidence interval
COVID-19
Coronavirus disease 2019
IBD
inflammatory bowel disease
ICU
intensive care unit
SMR
standardized mortality ratio
SECURE-IBD
Surveillance Epidemiology of Coronavirus Under Research Exclusion for Inflammatory Bowel Disease
TNF
tumor necrosis factor
UC
ulcerative colitis
5-ASA
5-aminosalicylate

Cited by (0)

Conflict of Interest These authors disclose the following: Ryan C. Ungaro: Supported by an NIH K23 Career Development Award (K23KD111995–01A1); has served as an advisory board member or consultant for Eli Lilly, Janssen, Pfizer, and Takeda; research support from AbbVie, Boehringer-Ingelheim, and Pfizer. Richard B. Gearry: Speaker fees and Scientific Advisory Boards for AbbVie and Janssen. Gilaad G. Kaplan: Received honoraria for speaking or consultancy from AbbVie, Janssen, Pfizer, and Takeda. He has received research support from Ferring, Janssen, Abbvie, GlaxoSmith Kline, Merck, and Shire. He shares ownership of a patent: TREATMENT OF INFLAMMATORY DISORDERS, AUTOIMMUNE DISEASE, AND PBC. UTI Limited Partnership, assignee. Patent WO2019046959A1. PCT/CA2018/051098. 7 Sept. 2018. Michele Kissous-Hunt: Speaker/consultant for AbbVie, Janssesn, Takeda. James Lewis: Personal fees from Johnson & Johnson Consumer Inc, grants, personal fees and other from Takeda Pharmaceuticals, personal fees and nonfinancial support from AbbVie, grants and personal fees from Janssen Pharmaceuticals, personal fees from Eli Lilly and Company, personal fees from Samsung Bioepis, personal fees from UCB, personal fees from Bristol-Myers Squibb, grants and personal fees from Nestle Health Science, personal fees from Bridge Biotherapeutics, personal fees from Celgene, personal fees from Merck, personal fees and other from Pfizer, personal fees from Gilead, personal fees from Arena Parmaceuticals, personal fees from Protagonist Therapeutics, outside the submitted work. Siew C. Ng: Received honoraria for speaking or consultancy from AbbVie, Janssen, Ferring, Tillotts and Takeda. She has received research support from Ferring and AbbVie. Jean-Francois Rahier: Received lecture fees from AbbVie, MSD, Takeda, Pfizer, Ferring, and Falk, consulting fees from AbbVie, Takeda, Hospira, Mundipharma, MSD, Pfizer, GlaxoSK, and Amgen, and research support from Takeda and AbbVie. Walter Reinisch: Served as a speaker for Abbott Laboratories, AbbVie, Aesca, Aptalis, Astellas, Centocor, Celltrion, Danone Austria, Elan, Falk Pharma GmbH, Ferring, Immundiagnostik, Mitsubishi Tanabe Pharma Corporation, MSD, Otsuka, PDL, Pharmacosmos, PLS Education, Schering-Plough, Shire, Takeda, Therakos, Vifor, Yakult. He has been a consultant for Abbott Laboratories, Abbvie, Aesca, Algernon, Amgen, AM Pharma, AMT, AOP Orphan, Arena Pharmaceuticals, Astellas, Astra Zeneca, Avaxia, Roland Berger GmbH, Bioclinica, Biogen IDEC, Boehringer-Ingelheim, Bristol-Myers Squibb, Cellerix, Chemocentryx, Celgene, Centocor, Celltrion, Covance, Danone Austria, DSM, Elan, Eli Lilly, Ernest & Young, Falk Pharma GmbH, Ferring, Galapagos, Genentech, Gilead, Grünenthal, ICON, Index Pharma, Inova, Intrinsic Imaging, Janssen, Johnson & Johnson, Kyowa Hakko Kirin Pharma, Lipid Therapeutics, LivaNova, Mallinckrodt, Medahead, MedImmune, Millenium, Mitsubishi Tanabe Pharma Corporation, MSD, Nash Pharmaceuticals, Nestle, Nippon Kayaku, Novartis, Ocera, OMass, Otsuka, Parexel, PDL, Periconsulting, Pharmacosmos, Philip Morris Institute, Pfizer, Procter & Gamble, Prometheus, Protagonist, Provention, Robarts Clinical Trial, Sandoz, Schering-Plough, Second Genome, Seres Therapeutics, Setpointmedical, Sigmoid, Sublimity, Takeda, Therakos, Theravance, Tigenix, UCB, Vifor, Zealand, Zyngenia, and 4SC. He has been an advisory board member for Abbott Laboratories, AbbVie, Aesca, Amgen, AM Pharma, Astellas, Astra Zeneca, Avaxia, Biogen IDEC, Boehringer-Ingelheim, Bristol-Myers Squibb, Cellerix, Chemocentryx, Celgene, Centocor, Celltrion, Danone Austria, DSM, Elan, Ferring, Galapagos, Genentech, Grünenthal, Inova, Janssen, Johnson & Johnson, Kyowa Hakko Kirin Pharma, Lipid Therapeutics, MedImmune, Millenium, Mitsubishi Tanabe Pharma Corporation, MSD, Nestle, Novartis, Ocera, Otsuka, PDL, Pharmacosmos, Pfizer, Procter & Gamble, Prometheus, Sandoz, Schering-Plough, Second Genome, Setpointmedical, Takeda, Therakos, Tigenix, UCB, Zealand, Zyngenia, and 4SC. He has received research funding from Abbott Laboratories, Abbvie, Aesca, Centocor, Falk Pharma GmbH, Immundiagnsotik, and MSD. Frank Ruemmele: Received consultation fee, research grant, or honorarium from Janssen, Pfizer, AbbVie, Takeda, Celgene, Nestlé Health Science, Nestlé Nutrition Institute. Flavio Steinwurz: Speaker and consultant for AbbVie, Eurofarma, Ferring, Janssen, Pfizer, Sanofi, Takeda, and UCB. Jean-Frederic Colombel: Research grants from AbbVie, Janssen Pharmaceuticals and Takeda; receiving payment for lectures from AbbVie, Amgen, Allergan, Inc. Ferring Pharmaceuticals, Shire, and Takeda; receiving consulting fees from AbbVie, Amgen, Arena Pharmaceuticals, Boehringer-Ingelheim, Celgene Corporation, Celltrion, Eli Lilly, Enterome, Ferring Pharmaceuticals, Genentech, Janssen Pharmaceuticals, Landos, Ipsen, Medimmune, Merck, Novartis, Pfizer, Shire, Takeda, Tigenix, Viela bio; and hold stock options in Intestinal Biotech Development, and Genfit. Michael D. Kappelman: Consulted for AbbVie, Janssen, and Takeda, is a shareholder in Johnson & Johnson, and has received research support from AbbVie and Janssen. The remaining authors disclose no conflicts.

Funding This work was funded by CTSA grant number UL1TR002489 and K23KD111995–01A1 (to Ryan C. Ungaro). The study sponsor (National Institutes of Health) had no role in the collection, analysis, and interpretation of data.

Author names in bold designate shared co-first authorship.

Authors share co-first authorship

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