Worse COVID-19 outcomes in IBD patients taking corticosteroids

Last Updated: 2020-05-18

By Reuters Staff

NEW YORK (Reuters Health) - Corticosteroids appear to worsen COVID-19 outcomes in patients with inflammatory bowel disease (IBD), but TNF antagonists do not, according to an international registry study.

At this stage of the COVID-19 pandemic, little is known about its impact on patients with IBD, particularly those who require systemic immunosuppressant medications.

Dr. Erica J. Brenner from University of North Carolina, Chapel Hill, and colleagues created the Surveillance Epidemiology of Coronavirus Under Research Exclusion for Inflammatory Bowel Disease (SECURE-IBD) database and used it to evaluate the clinical course of COVID-19 and risk factors for adverse outcomes of 525 cases from 33 countries and 28 U.S. states.

Most patients had Crohn's disease (59.4%) and were classified as being in remission (58.9%). IBD treatment included TNF antagonist therapy in 43.4% of patients, and about one-third of patients (36.6%) had other comorbidities.

Overall, 31% of these patients required hospitalization, 5% spent time in an ICU, and 4% used a ventilator. A total of 7% experienced the primary outcome of ICU admission/ventilator/death, according to the online report in Gastroenterology.

Nine of the 37 patients on systemic corticosteroids (24%) experienced the primary endpoint.

There were 16 deaths, 8 of them in patients age 70 or older and none of them in patients under age 30. Most of the patients who died had comorbidities, including 8 with cardiovascular disease.

On multivariable analysis, factors independently associated with the primary endpoint included the use of systemic corticosteroids (6.9-fold increased odds), the use of 5-acetylsalicylic acid/sulfasalazine (3.1-fold increased odds), having at least 2 comorbidities (2.9-fold increased odds), and increasing age.

There was no significant association between TNF antagonist use and the primary endpoint.

In an exploratory analysis, however, TNF antagonist combination therapy was associated with 5.0-fold increased odds of hospitalization or death, compared with TNF antagonist monotherapy.

"Maintaining remission with steroid-sparing treatments will be important in managing patients with IBD through this pandemic," the authors conclude. "It appears that TNF antagonist therapy is not associated with severe COVID-19, providing reassurance that patients can continue (on it)."

Dr. Brenner and co-author Dr. Ryan C. Ungaro from Icahn School of Medicine at Mount Sinai, New York, did not respond to a request for comments.

SOURCE: https://bit.ly/3bJVuyx Gastroenterology, online May 18, 2020.