Immunosuppressive Therapy and Risk of COVID-19 Infection in Patients With Inflammatory Bowel Diseases

Inflamm Bowel Dis. 2020 Oct 22;izaa278. doi: 10.1093/ibd/izaa278. Online ahead of print.

Kristin E Burke 1 2, Bharati Kochar 1 2, Jessica R Allegretti 2 3, Rachel W Winter 2 3, Paul Lochhead 1 2, Hamed Khalili 1 2, Francis P Colizzo 1 2, Matthew J Hamilton 2 3, Walter W Chan 2 3, Ashwin N Ananthakrishnan 1 2


Author information

  • 1Crohn's and Colitis Center, Massachusetts General Hospital, Boston, MA.
  • 2Harvard Medical School, Boston, MA.
  • 3Crohn's and Colitis Center, Brigham and Women's Hospital, Boston, MA.


Background: The effect of immunosuppressive treatment for immune-mediated diseases on risk of the novel coronavirus disease 2019 (COVID-19) has not been established. We aimed to define the effect of targeted biologic and immunomodulator therapy on risk of COVID-19 in a multi-institutional cohort of patients with inflammatory bowel disease (IBD).

Methods: We identified patients 18 years and older who received care for IBD at Partners Healthcare between January 2019 and April 2020. The primary outcome was development of COVID-19 defined as a positive polymerase chain reaction test for severe acute respiratory syndrome coronavirus 2. Multivariable regression models were used to examine the effect of immunosuppression on risk of COVID-19 and its outcomes.

Results: In a cohort of 5302 IBD patients, 39 (0.7%) developed COVID-19. There was no difference in age, sex, or race between IBD patients with and without COVID-19. The rate of COVID-19 was similar between patients treated with immunosuppression (0.8%) compared with those who were not (0.64%; P = 0.55). After adjusting for age, sex, race, and comorbidities, use of immunosuppressive therapy was not associated with an increased risk of COVID-19 (odds ratio, 1.73; 95% confidence interval, 0.82-3.63). The presence of obesity was associated with a higher risk of COVID-19 (odds ratio, 8.29; 95% confidence interval, 3.72-18.47). There were 7 hospitalizations, 3 intensive care unit stays, and 1 death. Older age and obesity but not immunosuppressive treatment were associated with severe COVID-19 infection.

Conclusions: The use of systemic immunosuppression was not associated with an increased risk of COVID-19 in a multi-institutional cohort of patients with IBD.

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