Risk of severe COVID-19 in patients treated with IBD medications: a French nationwide study

Aliment Pharmacol Ther. 2021 Jul;54(2):160-166. doi: 10.1111/apt.16410. Epub 2021 Jun 10.

Antoine Meyer 1 2 3, Laura Semenzato 1, Mahmoud Zureik 1 4, Alain Weill 1, Franck Carbonnel 2 3, Rosemary Dray-Spira 1


Author information

  • 1EPIPHARE, Épidémiologie des produits de santé, ANSM-CNAM, Saint Denis, France.
  • 2Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Le Kremlin Bicêtre, France.
  • 3Université Paris Saclay, Le Kremlin Bicêtre, France.
  • 4Université Versailles Saint-Quentin en Yvelines, Montigny le Bretonneux, France.


Background: Recently, the SECURE-IBD study, based on a physician-reported registry, suggested that thiopurines, either alone or combined with anti-TNF, may increase risk of severe COVID-19.

Aims: To compare the risk of severe COVID-19 according to IBD medications in a large and unselected population.

Methods: Using the French national health data system, the risks of hospitalisation and of death or mechanical ventilation for COVID-19 from 15 February 2020 to 31 August 2020 in IBD patients were compared according to IBD treatment (immunomodulators and biologics), using multivariable Cox models adjusted for socio-demographic characteristics, budesonide/corticosteroids and aminosalicylates use, and comorbidities.

Results: Among 268 185 IBD patients, 600 were hospitalised for COVID-19 and 111 of them died or were mechanically ventilated (including 78 deaths). In multivariable analysis, the risk of hospitalisation for COVID-19 did not differ according to IBD treatment category, with adjusted Hazard Ratios (aHR, unexposed patients used as reference) of 0.94 (95%CI: 0.66-1.35) for immunomodulator monotherapy, 1.05 (0.80-1.38) for anti-TNF monotherapy, 0.80 (0.38-1.69) for anti-TNF combination therapy, 1.06 (0.55-2.05) for vedolizumab and 1.25 (0.64-2.43) for ustekinumab. Similarly, the risk of death or mechanical ventilation for COVID-19 did not differ according to IBD treatment.

Conclusions: Immunomodulators and biologics prescribed in patients with IBD do not appear to increase the severity of COVID-19 infection.


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