Display options
Cite
Ardizzone S, Ferretti F, Monico MC, et al. Lower incidence of COVID-19 in patients with inflammatory bowel disease treated with non-gut selective biologic therapy. J Gastroenterol Hepatol. 2021;36(11):3050-3055doi: 10.1111/jgh.15591.
Ardizzone, S., Ferretti, F., Monico, M. C., Carvalhas Gabrielli, A. M., Carmagnola, S., Bezzio, C., Saibeni, S., Bosani, M., Caprioli, F., Mazza, S., Casini, V., Cortelezzi, C. C., Parravicini, M., Cassinotti, A., Cosimo, P., Indriolo, A., Di Sabatino, A., Lenti, M. V., Pastorelli, L., Conforti, F., Ricci, C., Sarzi-Puttini, P., Vecchi, M., & Maconi, G. (2021). Lower incidence of COVID-19 in patients with inflammatory bowel disease treated with non-gut selective biologic therapy. Journal of gastroenterology and hepatology, 36(11), 3050-3055. https://doi.org/10.1111/jgh.15591
Ardizzone, Sandro, et al. "Lower incidence of COVID-19 in patients with inflammatory bowel disease treated with non-gut selective biologic therapy." Journal of gastroenterology and hepatology vol. 36,11 (2021): 3050-3055. doi: https://doi.org/10.1111/jgh.15591
Ardizzone S, Ferretti F, Monico MC, Carvalhas Gabrielli AM, Carmagnola S, Bezzio C, Saibeni S, Bosani M, Caprioli F, Mazza S, Casini V, Cortelezzi CC, Parravicini M, Cassinotti A, Cosimo P, Indriolo A, Di Sabatino A, Lenti MV, Pastorelli L, Conforti F, Ricci C, Sarzi-Puttini P, Vecchi M, Maconi G. Lower incidence of COVID-19 in patients with inflammatory bowel disease treated with non-gut selective biologic therapy. J Gastroenterol Hepatol. 2021 Nov;36(11):3050-3055. doi: 10.1111/jgh.15591. Epub 2021 Jul 05. PMID: 34159648; PMCID: PMC8447454.
Copy Download .nbib Format: NLM
Share it on

J Gastroenterol Hepatol. 2021 Nov;36(11):3050-3055. doi: 10.1111/jgh.15591. Epub 2021 Jul 05.

Lower incidence of COVID-19 in patients with inflammatory bowel disease treated with non-gut selective biologic therapy.

Journal of gastroenterology and hepatology

Sandro Ardizzone, Francesca Ferretti, Maria Camilla Monico, Anna Maria Carvalhas Gabrielli, Stefania Carmagnola, Cristina Bezzio, Simone Saibeni, Matteo Bosani, Flavio Caprioli, Stefano Mazza, Valentina Casini, Claudio Camillo Cortelezzi, Marco Parravicini, Andrea Cassinotti, Paola Cosimo, Amedeo Indriolo, Antonio Di Sabatino, Marco Vincenzo Lenti, Luca Pastorelli, Francesco Conforti, Chiara Ricci, Piercarlo Sarzi-Puttini, Maurizio Vecchi, Giovanni Maconi

Affiliations

  1. Gastroenterology Unit, ASST Fatebenefratelli-Sacco, L. Sacco University Hospital, Department of Biochemical and Clinical Sciences, University of Milan, Milan, Italy.
  2. Gastroenterology Unit, ASST Rhodense, Rho Hospital, Rho, Italy.
  3. ASST Ovest Milanese, Legnano Hospital, Legnano, Italy.
  4. Gastroenterology and Endoscopy Unit, IRCCS Ca' Granda Ospedale Maggiore Policlinico Foundation, Milan, Italy.
  5. Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
  6. UOC Gastroenterology and Digestive Endoscopy, ASST Bergamo Est, Seriate, Bergamo, Italy.
  7. ASST Sette Laghi, Gastroenterology and Endoscopy Unit, Circolo Hospital and Macchi Foundation, Varese, Italy.
  8. Gastroenterology and Endoscopy Unit, Papa Giovanni XXIII Hospital, Bergamo, Italy.
  9. Department of Internal Medicine, IRCCS San Matteo Hospital Foundation, University of Pavia, Pavia, Italy.
  10. Gastroenterology Unit, IRCCS Policlinico San Donato Research Hospital, Milan, Italy.
  11. Gastroenterology Unit, Spedali Civili Hospital, Department of Experimental and Clinical Sciences, University of Brescia, Brescia, Italy.
  12. Rheumatology Unit, ASST-Fatebenefratelli L. Sacco University Hospital, University of Milan, Milan, Italy.

PMID: 34159648 PMCID: PMC8447454 DOI: 10.1111/jgh.15591

Abstract

BACKGROUND AND AIM: Since the outbreak of COVID-19, concerns have been raised as to whether inflammatory bowel disease (IBD) patients under biologic therapy may be more susceptible to the disease. This study aimed to determine the incidence and outcomes of COVID-19 in a large cohort of IBD patients on biologic therapy.

METHODS: This observational retrospective multicenter study collected data about COVID-19 in IBD patients on biologic therapy in Italy, between February and May 2020. The main end-points were (i) to assess both the cumulative incidence and clinical outcome of COVID-19, according to different biologic agents and (ii) to compare them with the general population and a cohort IBD patients undergoing non-biologic therapies.

RESULTS: Among 1816 IBD patients, the cumulative incidence of COVID-19 was 3.9 per 1000 (7/1816) with a 57% hospitalization rate and a 29% case-fatality rate. The class of biologic agents was the only risk factor of developing COVID-19 (P = 0.01). Non-gut selective agents were associated with a lower incidence of COVID-19 cases, related symptoms, and hospitalization (P < 0.05). Compared with the general population of Lombardy, an overall lower incidence of COVID-19 was observed (3.9 vs 8.5 per 1000, P = 0.03). Compared with 565 IBD patients on non-biologic therapies, a lower rate of COVID-19 symptoms was observed in our cohort (7.5% vs 18%, P < 0.001).

CONCLUSIONS: Compared with the general population, IBD patients on biologic therapy are not exposed to a higher risk of COVID-19. Non-gut selective agents are associated with a lower incidence of symptomatic disease, supporting the decision of maintaining the ongoing treatment.

© 2021 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.

Keywords: Biologic therapy; COVID-19; Inflammatory bowel disease; SARS-CoV-2

References

  1. Morens DM, Daszak P, Taubenberger JK. Escaping Pandora's box-another novel coronavirus. N. Engl. J. Med. 2020; 382: 1293-1295. - PubMed
  2. The Civil Protection Deparment of the Italian Government. COVID-19 nation surveillance. Available at: http://www.protezionecivile.gov.it/. [Accessed: 24 October 2020]. - PubMed
  3. Zhou F, Yu T, Du R et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet 2020; 395: 1054-1062. - PubMed
  4. Onder G, Rezza G, Brusaferro S. Case-fatality rate and characteristics of patients dying in relation to COVID-19 in Italy. JAMA 2020; 323: 1775-1776. - PubMed
  5. El-Gabalawy H, Guenther LC, Bernstein CN. Epidemiology of immune-mediated inflammatory diseases: incidence, prevalence, natural history, and comorbidities. J. Rheumatol. Suppl. 2010; 85: 2-10. - PubMed
  6. Neurath MF. Current and emerging therapeutic targets for IBD. Nat. Rev. Gastroenterol. Hepatol. 2017; 14: 269-278. - PubMed
  7. Rahier JF, Magro F, Abreu C et al. Second European evidence-based consensus on the prevention, diagnosis and management of opportunistic infections in inflammatory bowel disease. J. Crohns Colitis 2014; 8: 443-468. - PubMed
  8. An P, Ji M, Ren H et al. Prevention of COVID-19 in patients with inflammatory bowel disease in Wuhan, China. Lancet Gastroenterol. Hepatol. 2020; 5: 525-527. - PubMed
  9. Norsa L, Indriolo A, Sansotta N, Cosimo P, Greco S, D'Antiga L. Uneventful course in patients with inflammatory bowel disease during the severe acute respiratory syndrome coronavirus 2 outbreak in Northern Italy. Gastroenterology 2020; 159: 371-372. - PubMed
  10. Mao R, Rieder F, Ben-Horin S et al. Implications of COVID-19 for patients with pre-existing digestive diseases: an update. Lancet Gastroenterol. Hepatol. 2021. - PubMed
  11. Derikx LAAP, Lantinga MA, de Jong DJ et al. Clinical outcomes of Covid-19 in patients with inflammatory bowel disease: a nationwide cohort study. J. Crohns Colitis 2020. - PubMed
  12. Ungaro RC, Brenner EJ, Gearry RB et al. Effect of IBD medications on COVID-19 outcomes: results from an international registry. Gut 2020. - PubMed
  13. Ferroni E, Giorgi Rossi P, Spila Alegiani S et al. Survival of hospitalized COVID-19 patients in Northern Italy: a population-based cohort study by the ITA-COVID-19 Network. Clin. Epidemiol. 2020; 12: 1337-1346. - PubMed
  14. Maconi G, Bosetti C, De Monti A et al. Risk of COVID 19 in patients with inflammatory bowel diseases compared to a control population. Dig. Liver Dis. 2020. - PubMed
  15. Italian National Institute of Statistics. http://dati.istat.it. [Accessed: 24 October 2020]. - PubMed
  16. EpiCentro-Epidemiology for public health Italian National Institute of Health (Istituto Superiore di Sanità I). https://www.epicentro.iss.it/. Accessed [Accessed: 24 October 2020]. - PubMed
  17. Monteleone G, Sarzi-Puttini PC, Ardizzone S. Preventing COVID-19-induced pneumonia with anticytokine therapy. Lancet Rheumatol. 2020; 2: e255-e256. - PubMed
  18. Neurath MF. COVID-19 and immunomodulation in IBD. Gut 2020; 69: 1335-1342. - PubMed
  19. Mehta P, McAuley DF, Brown M et al. COVID-19: consider cytokine storm syndromes and immunosuppression. Lancet 2020; 395: 1033-1034. - PubMed
  20. Bezzio C, Manes G, Bini F, Pellegrini L, Saibeni S. Infliximab for severe ulcerative colitis and subsequent SARS-CoV-2 pneumonia: a stone for two birds. Gut 2021; 70: 623-624. - PubMed
  21. Lamb CA, O'Byrne S, Keir ME, Butcher EC. Gut-selective integrin-targeted therapies for inflammatory bowel disease. J. Crohns Colitis 2018; 12: S653-S668. - PubMed
  22. Wyant T, Leach T, Sankoh S et al. Vedolizumab affects antibody responses to immunisation selectively in the gastrointestinal tract: randomised controlled trial results. Gut 2015; 64: 77-83. - PubMed
  23. Sarzi-Puttini P, Marotto D, Antivalle M et al. How to handle patients with autoimmune rheumatic and inflammatory bowel diseases in the COVID-19 era: an expert opinion. Autoimmun. Rev. 2020; 19: 102574. - PubMed
  24. Taxonera C, Sagastagoitia I, Alba C, Mañas N, Olivares D, Rey E. 2019 Novel coronavirus disease (COVID-19) in patients with inflammatory bowel diseases. Aliment. Pharmacol. Ther. 2020; 52: 276-283. - PubMed
  25. Khan N, Patel D, Xie D, Lewis J, Trivedi C, Yang YX. Impact of anti-tumor necrosis factor and thiopurine medications on the development of COVID-19 in patients with inflammatory bowel disease: a nationwide veterans administration cohort study. Gastroenterology 2020; 159: 1545, e1541-1546. - PubMed
  26. Bezzio C, Saibeni S, Variola A et al. Outcomes of COVID-19 in 79 patients with IBD in Italy: an IG-IBD study. Gut 2020; 69: 1213-1217. - PubMed
  27. Brenner EJ, Ungaro RC, Gearry RB 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; 159: 481-491. - PubMed
  28. Horby P, Lim WS, Emberson JR et al. Dexamethasone in hospitalized patients with Covid-19. N. Engl. J. Med. 2021; 384: 693-704. - PubMed
  29. WHO. Corticosteroids for COVID-19. Living guidance. September 2020. Reference number: WHO/2019-nCoV/Corticosteroids/2020.1. - PubMed

Publication Types