IBD meds & COVID-19 outcomes

July 20, 2021

Issue 14

Clinical Question

Do COVID-19 outcomes differ by type of IBD medication?

Editor’s Bottom Line

These results confirm other reports that systemic steroid therapy increases the risk of CoVID hospitalization but that advanced therapies have no effect. 5ASA therapy was not associated with worse outcomes in this large population-based cohort.

Reference

Meyer A, Semenzato L, Zureik M, et al. Risk of severe COVID-19 in patients treated with IBD medications: a French nationwide study. Aliment Pharmacol Therapeut. Epub ahead of print June 10, 2021; https://doi.org/10.1111/apt.16410

Synopsis

Researchers analyzed data from 268,185 IBD patients collected between February and August 2020 and included in the French national health data system. Seventy-four percent of patients were not being medically treated at the time, while 6.6% were receiving an immunomodulator, 14.3% were treated with anti-tumor necrosis factor (TNF) monotherapy, 2.2% were receiving combination anti-TNF treatment, and 1.5% and 1.7% were treated with vedolizumab or ustekinumab, respectively. Approximately 29% of patients were receiving an aminosalicylate and 15.1% were treated with a corticosteroid during the study period. Patients were a median 50 years of age and were roughly split evenly by sex.

Their findings showed that 0.22% of these individuals were hospitalised for COVID-19 and 0.04% died or required mechanical ventilation during hospitalization. Multivariate analyses controlling for a number of variables—such as tobacco or alcohol use, comorbidities and socio-economic status—found that risk of COVID-19-related hospitalization did not differ according to IBD treatment type (adjusted Hazard Ratio [aHR]: 0.94 for immunomodulator monotherapy vs. no immunomodulator monotherapy; 95% Confidence Interval [CI]: 0.66–1.35, and aHR: 1.05; 95% CI, 0.80–1.38 for anti-TNF monotherapy, and aHR: 0.80; 95% CI, 0.38–1.69 for anti-TNF combination therapy, and aHR: 1.06; 95% CI, 0.55–2.05 for vedolizumab, and aHR: 1.25; 95% CI, 0.64–2.43 for ustekinumab. The risk of death or mechanical ventilation for COVID-19 also did not differ according to IBD treatment.

Corticosteroid use was associated with a higher likelihood of hospitalization (aHR: 1.64; 95% CI, 1.35–1.98) and aminosalicylates were associated with a lower risk of hospitalization (aHR: 0.8; 95% CI, 0.67–0.97), while these medications did not correlate with risk of death or mechanical ventilation.

Details

Study Design: Retrospective cohort

Funding: Not stated

Allocation: None

Setting: National database

Level of Evidence: 2b