Patients with Inflammatory Bowel Disease Are Not at Increased Risk of COVID-19: A Large Multinational Cohort Study

Mariangela Allocca; María Chaparro; Haidee Aleman Gonzalez; Marta Maia Bosca-Watts; Carolina Palmela; Ferdinando D'Amico; Eirini Zacharopoulou; Uri Kopylov; Pierre Ellul; Giorgos Bamias; Vassilios Ntelis; Adi Lahat; Gerassimos J Mantzaris; Ioannis Papaconstantinou; Konstantinos Katsanos; Yulia Uspenskaya; Dimitrios Christodoulou; Shomron Ben Horin; Laurent Peyrin-Biroulet; Joanna Torres; Shaji Sebastian; Javier P Gisbert; Silvio Danese; Gionata Fiorino

doi:10.3390/jcm9113533

Patients with Inflammatory Bowel Disease Are Not at Increased Risk of COVID-19: A Large Multinational Cohort Study

J Clin Med. 2020 Oct 31;9(11):3533. doi: 10.3390/jcm9113533.

Authors

Mariangela Allocca^{1

2}, María Chaparro³, Haidee Aleman Gonzalez⁴, Marta Maia Bosca-Watts⁵, Carolina Palmela⁶, Ferdinando D'Amico^{2

7}, Eirini Zacharopoulou¹, Uri Kopylov⁸, Pierre Ellul⁹, Giorgos Bamias¹⁰, Vassilios Ntelis¹¹, Adi Lahat⁸, Gerassimos J Mantzaris¹², Ioannis Papaconstantinou¹³, Konstantinos Katsanos¹⁴, Yulia Uspenskaya¹⁵, Dimitrios Christodoulou¹⁴, Shomron Ben Horin⁸, Laurent Peyrin-Biroulet⁷, Joanna Torres⁶, Shaji Sebastian⁴, Javier P Gisbert³, Silvio Danese^{1

2}, Gionata Fiorino²

Affiliations

¹ Humanitas Clinical and Research Center-IRCCS-, via Manzoni 56, 20089 Rozzano, Milan, Italy.
² Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy.
³ Gastroenterology Unit, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), 28001 Madrid, Spain.
⁴ IBD Unit, Hull University Hospitals NHS Trust, Hull HU1, UK.
⁵ IBD Unit, Digestive Disease Department, University of Valencia, University Clinic Hospital of Valencia, 46010 València, Spain.
⁶ Division of Gastroenterology, Hospital Beatriz Ângelo, 2620 Loures, Portugal.
⁷ Department of Gastroenterology, Inserm U1256 NGERE, Nancy University Hospital, Lorraine University, 54500 Vandoeuvre-les-Nancy, France.
⁸ Department of Gastroenterology, Sheba Medical Center, Ramat Gan and Sackler School of Medicine, Tel Aviv University, Jaffa 59623, Israel.
⁹ Division of Gastroenterology, Mater Dei Hospital, MT-34 Msida, Malta.
¹⁰ GI-Unit, 3rd Academic Department of Internal Medicine, Sotiria Hospital, Medical School, National and Kapodistrian University of Athens, 210 Athens, Greece.
¹¹ G.Gennimatas General Hospital, 210 Athens, Greece.
¹² Department of Gastroenterology, GHA Evaggelismos-Ophthalmiatreion Athinon-Polykliniki, 210 Athens, Greece.
¹³ 2nd Academic Department of Surgery, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, 210 Athens, Greece.
¹⁴ Division of Gastroenterology, University Hospital and University of Ioannina, 440 Ioannina, Greece.
¹⁵ Medical Center "Ne Bolit" LTT, Leninsky Prospect, 66 Moscow, Russia.

Abstract

The impact of COVID-19 on inflammatory bowel disease (IBD) patients under pharmacological immunosuppression is still not clearly understood. We investigated the incidence of COVID-19 and the impact of immunosuppression and containment measures on the risk of SARS-CoV-2 infection in a large IBD cohort, from a multicenter cohort from 21st of February to 30th of June, 2020. Ninety-seven patients with IBD (43 UC, 53 CD, one unclassified IBD) and concomitant COVID-19 over a total of 23,879 patients with IBD were enrolled in the study. The cumulative incidence of SARS-CoV-2 infection in patients with IBD vs. the general population was 0.406% and 0.402% cases, respectively. Twenty-three patients (24%) were hospitalized, 21 (22%) had pneumonia, four (4%) were admitted to the Intensive Care Unit, and one patient died. Lethality in our cohort was 1% compared to 9% in the general population. At multivariable analysis, age > 65 years was associated with increased risk of pneumonia and hospitalization (OR 11.6, 95% CI 2.18-62.60; OR 5.1, 95% CI 1.10-23.86, respectively), treatment with corticosteroids increased the risk of hospitalization (OR 7.6, 95% CI 1.48-40.05), whereas monoclonal antibodies were associated with reduced risk of pneumonia and hospitalization (OR 0.1, 95% CI 0.04-0.52; OR 0.3, 95% CI 0.10-0.90, respectively). The risk of COVID-19 in patients with IBD is similar to the general population. National lockdown was effective in preventing infection in our cohort. Advanced age and treatment with corticosteroids impacted negatively on the outcome of COVID-19, whereas monoclonal antibodies did not seem to have a detrimental effect.

Keywords: COVID-19; drugs; immunosuppression; inflammatory bowel disease.