Impact of COVID-19 Treatment on Real-World Outcomes in Inflammatory Bowel Disease

Dig Dis Sci. 2024 May;69(5):1654-1660. doi: 10.1007/s10620-024-08355-3. Epub 2024 Mar 11.

Abstract

Background: While there are multiple safe and effective agents for COVID-19 treatment, their impact in inflammatory bowel disease (IBD) remains uncertain.

Aims: Our objective was to assess the effects of these therapies on both IBD and COVID outcomes.

Methods: A single-center retrospective study of adult patients with IBD who contracted COVID-19 between 12/2020 and 11/2022 was performed. Patients were stratified by COVID-19 treatment (antivirals and/or intravenous antibodies) vs no therapy. The primary outcome was the development of severe COVID-19 infection, defined by need for supplemental oxygen, corticosteroids and/or antibiotics, or hospitalization. Secondary outcomes included rates of withholding advanced IBD therapy (defined as biologic agents or small molecules) and of post-COVID-19 IBD flare.

Results: Of 127 patients with COVID-19 infection, 70% were on advanced therapies, 35% received COVID-19 treatment, and 15% developed severe COVID-19. Those treated for COVID-19 were more likely to be on corticosteroids [odds ratio (OR) 4.61, 95% confidence interval (CI) 1.72-12.39, p = 0.002] or advanced IBD therapies (OR 2.78, 95% CI 1.04-7.43, p = 0.041). After adjusting for age, race, sex, corticosteroid use, obesity, COVID-19 vaccination status, and severe COVID-19 infection, those treated for COVID-19 were more likely to have IBD therapy held (OR 6.95, 95% CI 1.72-28.15, p = 0.007). There was no significant difference in rates of post-COVID-19 IBD flares or severe COVID-19 infection. There were no COVID-related deaths.

Conclusions: Patients with IBD on advanced therapies were frequently treated for acute COVID-19. Although COVID-19 treatment was associated with temporary withholding of IBD therapy, it did not result in increased IBD flares.

Keywords: COVID 19; COVID 19 drug treatment; Crohn’s disease; Inflammatory bowel disease; Patient relevant outcomes; Ulcerative colitis.

MeSH terms

  • Adrenal Cortex Hormones / therapeutic use
  • Adult
  • Aged
  • Antiviral Agents / therapeutic use
  • COVID-19 Drug Treatment
  • COVID-19* / epidemiology
  • Female
  • Humans
  • Inflammatory Bowel Diseases* / drug therapy
  • Male
  • Middle Aged
  • Retrospective Studies
  • SARS-CoV-2
  • Treatment Outcome