COVID-19 Does Not Lead to an Increase in Corticosteroid Prescriptions in IBD Patients: A Nationwide Cohort Study

Bente Mertz Nørgård; Floor Dijkstra Zegers; Jan Nielsen; Torben Knudsen; Jens Kjeldsen

doi:10.1093/ibd/izad070

COVID-19 Does Not Lead to an Increase in Corticosteroid Prescriptions in IBD Patients: A Nationwide Cohort Study

Inflamm Bowel Dis. 2023 Sep 1;29(9):1470-1476. doi: 10.1093/ibd/izad070.

Authors

Bente Mertz Nørgård^{1

2}, Floor Dijkstra Zegers^{1

2}, Jan Nielsen^{1

2}, Torben Knudsen^{3

4}, Jens Kjeldsen^{5

6}

Affiliations

¹ Center for Clinical Epidemiology, Odense University Hospital, 5000 Odense C, Denmark.
² Research Unit of Clinical Epidemiology, Department of Clinical Research, University of Southern Denmark, 5000 Odense C, Denmark.
³ Department of Medical Gastroenterology, Hospital of Southwest Jutland, Esbjerg, Denmark.
⁴ Department of Regional Health Science, University of Southern Denmark, Esbjerg, Denmark.
⁵ Department of Medical Gastroenterology S, Odense University Hospital, 5000 Odense C, Denmark.
⁶ Research Unit of Medical Gastroenterology, Department of Clinical Research, University of Southern Denmark, 5000 Odense C, Denmark.

PMID: 37067508
DOI: 10.1093/ibd/izad070

Abstract

Background: It is not known whether coronavirus 2019 (COVID-19) is a trigger for disease activity in patients with inflammatory bowel diseases (IBD). In patients with IBD, we aimed to examine the association between COVID-19 infection and prescriptions of systemic and local corticosteroids (used as proxy for disease activity).

Methods: This nationwide cohort study was based on Danish health registries and included all patients in Denmark with ulcerative colitis (UC) or Crohn's disease (CD) by the start of the pandemic (March 1, 2020) and who had a positive COVID-19 polymerase chain reaction (PCR) test from March 1, 2020, to July 31, 2022. We calculated rates of corticosteroid prescriptions 6 months before and 6 months after a positive COVID-19 PCR test, and we calculated adjusted incidence rate ratios (aIRR).

Results: We included 30,102 patients with IBD and a positive COVID-19 test (11,159 with CD, 18,493 with UC). The aIRR for having corticosteroid prescriptions after a COVID-19 positive test was 0.85 (95% confidence interval [CI], 0.79-0.91). When we stratified for underlying disease, the aIRR for having corticosteroid after a COVID-19 positive test in UC was 0.82 (95% CI, 0.75-0.90), and in CD 0.91 (95% CI, 0.81-1.02). Stratifications according to calendar periods and age groups showed consistent results.

Conclusions: An infection with COVID-19 did not result in a higher rate of filled corticosteroid prescriptions. Using corticosteroids as a proxy for disease activity, COVID-19 did not seem to trigger disease activity, which is a reassuring result for patients with IBD.

Keywords: COVID-19; IBD; corticosteroids; disease activity.

Plain language summary

An infection with COVID-19 did not result in a higher rate of filled corticosteroid prescriptions. Using corticosteroids as a proxy for disease activity, COVID-19 did not seem to trigger disease activity, which is a reassuring result for patients with IBD.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adrenal Cortex Hormones / therapeutic use
COVID-19* / complications
COVID-19* / epidemiology
Cohort Studies
Colitis, Ulcerative* / complications
Colitis, Ulcerative* / drug therapy
Colitis, Ulcerative* / epidemiology
Crohn Disease* / complications
Crohn Disease* / drug therapy
Crohn Disease* / epidemiology
Humans
Inflammatory Bowel Diseases* / complications
Inflammatory Bowel Diseases* / drug therapy
Inflammatory Bowel Diseases* / epidemiology
Prescriptions

Substances

Adrenal Cortex Hormones