Corticosteroids but not Anti-TNF Are Associated With Increased COVID-19 Complications in Patients With Inflammatory Bowel Disease

Millie D Long; Lauren Parlett; James D Lewis; Kevin Haynes; Sruthi Adimadhyam; Laura Hou; Audrey Wolfe; Sengwee Toh; Jessica Burris; Jennifer Dorand; Michael D Kappelman

doi:10.1093/ibd/izad176

Corticosteroids but not Anti-TNF Are Associated With Increased COVID-19 Complications in Patients With Inflammatory Bowel Disease

Inflamm Bowel Dis. 2023 Aug 23:izad176. doi: 10.1093/ibd/izad176. Online ahead of print.

Authors

Affiliations

¹ Department of Medicine and Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
² HealthCore, Inc, Newark, Delaware, USA.
³ Department of Medicine, Perlman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
⁴ Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA.
⁵ Crohn's and Colitis Foundation, New York, NY, USA.

PMID: 37611117
DOI: 10.1093/ibd/izad176

Abstract

Background and aims: Immunosuppressed individuals are at higher risk for COVID-19 complications, yet data in patients with inflammatory bowel disease (IBD) are limited. We evaluated the risk of COVID-19- severe sequelae by medication utilization in a large cohort of patients with IBD.

Methods: We conducted a retrospective cohort study utilizing insurance claims data between August 31, 2019, and August 31, 2021.We included IBD patients identified by diagnosis and treatment codes. Use of IBD medications was defined in the 90 days prior to cohort entry. Study outcomes included COVID-19 hospitalization, mechanical ventilation, and inpatient death. Patients were followed until the outcome of interest, outpatient death, disenrollment, or end of study period. Due to the aggregate nature of available data, we were unable to perform multivariate analyses.

Results: We included 102 986 patients (48 728 CD, 47 592 UC) with a mean age of 53 years; 55% were female. Overall, 412 (0.4%) patients were hospitalized with COVID-19. The incidence of hospitalization was higher in those on corticosteroids (0.6% vs 0.3%; P < .0001; 13.6 per 1000 person-years; 95% confidence interval [CI], 10.8-16.9) and lower in those receiving anti-tumor necrosis factor α therapy (0.2% vs 0.5%; P < .0001; 3.9 per 1000 person-years; 95% CI, 2.7-5.4). Older age was associated with increased hospitalization with COVID-19. Overall, 71 (0.07%) patients required mechanical ventilation and 52 (0.05%) died at the hospital with COVID-19. The proportion requiring mechanical ventilation (1.9% vs 0.05%; P < .0001; 3.9 per 1000 person-years; 95% CI, 2.5-5.9) was higher among users of corticosteroids.

Conclusions: Among patients with IBD, those on corticosteroids had more hospitalizations and mechanical ventilation with COVID-19. Anti-tumor necrosis factor α therapy was associated with a decreased risk of hospitalization. These findings reinforce previous guidance to taper and/or discontinue corticosteroids in IBD.

Keywords: CD; COVID-19; IBD; UC; hospitalization.