Abstract

COVID-19 in Patients with Inflammatory Bowel Disease: The Israeli Experience

Vaccines (Basel). 2022 Feb 28;10(3):376. doi: 10.3390/vaccines10030376.

Lev Lichtenstein 1, Benjamin Koslowsky 2, Ami Ben Ya'acov 2, Irit Avni-Biron 3 4, Baruch Ovadia 5, Ofer Ben-Bassat 6, Timna Naftali 4 7, Uri Kopylov 4 8, Yael Haberman 4 8, Hagar Banai Eran 3 4, Rami Eliakim 4 8, Adi Lahat-Zok 4 8, Ayal Hirsch 4 9, Eran Zittan 10 11, Nitsan Maharshak 4 9, Matti Waterman 11 12, Eran Israeli 4 13, Idan Goren 3 4, Jacob E Ollech 3 4, Henit Yanai 3 4, Bella Ungar 4 8, Benjamin Avidan 4 8, Dana Ben Hur 11 12, Bernardo Melamud 4 13, Ori Segol 14, Zippora Shalem 4 15, Iris Dotan 3 4, Selwyn H Odes 4 16, Shomron Ben-Horin 4 8, Yf'at Snir 3 4, Yael Milgrom 17, Efrat Broide 4 15, Eran Goldin 2, Shmuel Delgado 18, Yulia Ron 4 9, Nathaniel Aviv Cohen 4 9, Eran Maoz 1, Maya Zborovsky 1, Safwat Odeh 19, Naim Abu Freha 20, Eyal Shachar 4 8, Yehuda Chowers 11 12, Tal Engel 4 8, Hila Reiss-Mintz 4 16, Arie Segal 20, Adar Zinger 17, Ariella Bar-Gil Shitrit 2

 
     

Author information

1Clalit Health Services, Tel Aviv, Israel.

2Digestive Diseases Institute, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.

3Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel.

4Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.

5Department of Gastroenterology and Hepatology, Hillel Yaffe Medical Center, Hadera, Israel.

6Barzilai Medical Center, Ashkelon, Israel.

7Department of Gastroenterology and Liver Diseases, Meir Medical Center, Kfar Saba, Israel.

8Department of Gastroenterology, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.

9Sourasky Medical Center, Tel Aviv, Israel.

10Inflammatory Bowel Disease Unit, Ha'emek Medical Center, Faculty of Medicine, Israel Institute of Technology, Afula, Israel.

11Faculty of Medicine, Israel Institute of Technology, Haifa, Israel.

12Rambam Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.

13Department of Gastroenterology and Liver Diseases, Wolfson Medical Center, Holon, Israel.

14Unit of Gastroenterology, Lady Davis Carmel Medical Center, Haifa, Israel.

15Gastroenterology and Liver Diseases Institute, Shamir Medical Center, Be'er Ya'akov, Israel.

16Mayanei HaYeshua Medical Center, Bnei Brak, Israel.

17Hadassah Medical Center, Jerusalem, Israel.

18Assuta Medical Center, Ben-Gurion University, Negev, Be'er Sheva, Israel.

19Bnai Zion Medical Center, Haifa, Israel.

20Soroka Medical Center, Be'er Sheva, Israel.

Abstract

Background: Crohn's disease (CD) and ulcerative colitis (UC) are chronic, immune-mediated inflammatory bowel diseases (IBD) affecting millions of people worldwide. IBD therapies, designed for continuous immune suppression, often render patients more susceptible to infections. The effect of the immune suppression on the risk of coronavirus disease-19 (COVID-19) is not fully determined yet.

Objective: To describe COVID-19 characteristics and outcomes and to evaluate the association between IBD phenotypes, infection outcomes and immunomodulatory therapies.

Methods: In this multi-center study, we prospectively followed IBD patients with proven COVID-19. De-identified data from medical charts were collected including age, gender, IBD type, IBD clinical activity, IBD treatments, comorbidities, symptoms and outcomes of COVID-19. A multivariable regression model was used to examine the effect of immunosuppressant drugs on the risk of infection by COVID-19 and the outcomes.

Results: Of 144 IBD patients, 104 (72%) were CD and 40 (28%) were UC. Mean age was 32.2 ± 12.6 years. No mortalities were reported. In total, 94 patients (65.3%) received biologic therapy. Of them, 51 (54%) at escalated doses, 10 (11%) in combination with immunomodulators and 9 (10%) with concomitant corticosteroids. Disease location, behavior and activity did not correlate with the severity of COVID-19. Biologics as monotherapy or with immunomodulators or corticosteroids were not associated with more severe infection. On the contrary, patients receiving biologics had significantly milder infection course (p = 0.001) and were less likely to be hospitalized (p = 0.001). Treatment was postponed in 34.7% of patients until recovery from COVID-19, without consequent exacerbation.

Conclusion: We did not witness aggravated COVID-19 outcomes in patients with IBD. Patients treated with biologics had a favorable outcome.

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