Corticosteroids, but Not TNF Antagonists, Are Associated With Adverse COVID-19 Outcomes in Patients With Inflammatory Bowel Diseases: Results From an International Registry

Gastroenterology. 2020 May 18. doi: 10.1053/j.gastro.2020.05.032. Online ahead of print.

Erica J Brenner 1, Ryan C Ungaro 2, Richard B Gearry 3, Gilaad G Kaplan 4, Michele Kissous-Hunt 5, James D Lewis 6, Siew C Ng 7, Jean-Francois Rahier 8, Walter Reinisch 9, Frank M Ruemmele 10, Flavio Steinwurz 11, Fox E Underwood 12, Xian Zhang 13, Jean-Frederic Colombel 14, Michael D Kappelman 1


Author information

1University of North Carolina Department of Pediatric Gastroenterology Children's Hospital, 101 Manning Dr, Chapel Hill, NC 27514.

2The Henry D. Janowitz Division of Gastroenterology Icahn School of Medicine at Mount Sinai, 17 E 102nd St 5th Floor, New York, NY 10029.

3University of Otago Department of Medicine 2 Riccarton Avenue, Christchurch Central City, Christchurch 8011, New Zealand.

4University of Calgary, Departments of Medicine and Community Health Sciences Room 3D03-18, 3280 Hospital Drive NW, Calgary, Alberta, T2N 4Z6, Canada.

5Mount Sinai Medical Center, 1 Gustave L. Levy Place, New York, NY 10029 Fifth Ave GI, 1150 Fifth Avenue, Suite 1B, New York, NY 10128.

6The University of Pennsylvania 423 Guardian Drive, 720 Blockley Hall, Philadelphia, PA 19104-6021.

7Department of Medicine and Therapeutics, Institute of Digestive Disease, State Key Laboratory of Digestive Disease, Li Ka Shing Institute of Health Science, The Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR, The People's Republic of China.

8Department of Gastroenterology, Université catholique de Louvain, CHU UCL Namur 5530 Yvoir, Belgium.

9Medical University of Vienna Department Internal Medicine III, Division Gastroenterology & Hepatology; Währinger Gürtel 18-20, A-1090 Vienna, Austria.

10Université de Paris, France Assistance-Publique- Hôpitaux de Paris, Hôpital Necker Enfants Malades, Service de Gastroentérologie pédiatrique, 149 Rue de Sèvres, 75015 Paris, France.

11Hospital Israelita Albert Einstein Av. Albert Einstein, 627 - Jardim Leonor, São Paulo - SP, 05652-900, Brazil.

12University of Calgary, Departments of Medicine and Community Health Sciences Room HSC 1745, 2500 Hospital Drive NW, Calgary, Alberta, T2N 1N4, Canada.

13University of North Carolina Department of Gastroenterology 101 Manning Dr, Chapel Hill, NC 27514.

14The Henry D. Janowitz Division of GastroenterologyIcahn School of Medicine at Mount Sinai, 17 E 102nd St 5th Floor, New York, NY 10029.

Free PMC article


Background and aims: The impact of Coronavirus disease 2019 (COVID-19) on patients with inflammatory bowel disease (IBD) is unknown. We sought to characterize the clinical course of COVID-19 among IBD patients and evaluate the association between demographics, clinical characteristics, and immunosuppressant treatments on COVID-19 outcomes.

Methods: Surveillance Epidemiology of Coronavirus Under Research Exclusion for Inflammatory Bowel Disease (SECURE-IBD) is a large, international registry created to monitor outcomes of IBD patients with confirmed COVID-19. We calculated age-standardized mortality ratios (SMRs) and utilized multivariable logistic regression to identify factors associated with severe COVID-19, defined as intensive care unit admission, ventilator use, and/or death.

Results: 525 cases from 33 countries were reported (Median age 43 years, 53% men). Thirty-seven patients (7%) had severe COVID-19, 161 (31%) were hospitalized, and 16 patients died (3% case fatality rate). SMRs for IBD patients were 1.8 (95% confidence interval [CI] 0.9-2.6), 1.5 (95% CI 0.7-2.2), and 1.7 (95% CI 0.9-2.5) relative to data from China, Italy, and the US, respectively. Risk factors for severe COVID-19 among IBD patients included increasing age (adjusted odds ratio [aOR] 1.04, 95% CI 1.01-1.02), ≥2 comorbidities (aOR 2.9, 95% CI 1.1-7.8), systemic corticosteroids (aOR 6.9, 95% CI 2.3-20.5), and sulfasalazine or 5-aminosalicylate use (aOR 3.1, 95% CI 1.3-7.7). TNF antagonist treatment was not associated with severe COVID-19 (aOR 0.9, 95% CI 0.4-2.2).

Conclusions: Increasing age, comorbidities, and corticosteroids are associated with severe COVID-19 among IBD patients, although a causal relationship cannot be definitively established. Notably, TNF antagonists do not appear to be associated with severe COVID-19.

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