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Effect of IBD medications on COVID-19 outcomes: results from an international registry.

Authors
  • Ungaro, Ryan C1
  • Brenner, Erica J2
  • Gearry, Richard B3
  • Kaplan, Gilaad G4
  • Kissous-Hunt, Michele5, 6
  • Lewis, James D7
  • Ng, Siew C8
  • Rahier, Jean-Francois9
  • Reinisch, Walter10
  • Steinwurz, Flávio11
  • Underwood, Fox E4
  • Zhang, Xian2
  • Colombel, Jean-Frederic5
  • Kappelman, Michael D2
  • 1 The Henry D Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, USA [email protected]
  • 2 University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
  • 3 Department of Medicine, University of Otago, Christchurch, New Zealand. , (New Zealand)
  • 4 Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada. , (Canada)
  • 5 The Henry D Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
  • 6 Fifth Ave GI, New York, New York, USA.
  • 7 Division of Gastroenterology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
  • 8 Department of Medicine and Therapeutics, Institute of Digestive Disease, State Key Laboratory of Digestive Disease, Li Ka Shing Institute of Health Science, Chinese University of Hong Kong, Shatin, NT, Hong Kong. , (Hong Kong SAR China)
  • 9 Department of Gastroenterology, Université Catholique de Louvain, Yvoir, Belgium. , (Belgium)
  • 10 Department of Medicine IV, Medical University Vienna, Vienna, Austria. , (Austria)
  • 11 Department of Gastroenterology, Hospital Israelita Albert Einstein, Sao Paulo, Brazil. , (Brazil)
Type
Published Article
Journal
Gut
Publisher
BMJ
Publication Date
Apr 01, 2021
Volume
70
Issue
4
Pages
725–732
Identifiers
DOI: 10.1136/gutjnl-2020-322539
PMID: 33082265
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

We sought to evaluate COVID-19 clinical course in patients with IBD treated with different medication classes and combinations. 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 used multivariable regression with a generalised estimating equation accounting for country as a random effect to analyse the association of different medication classes with severe COVID-19, defined as intensive care unit admission, ventilator use and/or death. 1439 cases from 47 countries were included (mean age 44.1 years, 51.4% men) of whom 112 patients (7.8%) had severe COVID-19. Compared with tumour necrosis factor (TNF) antagonist monotherapy, thiopurine monotherapy (adjusted OR (aOR) 4.08, 95% CI 1.73 to 9.61) and combination therapy with TNF antagonist and thiopurine (aOR 4.01, 95% CI 1.65 to 9.78) were associated with an increased risk of severe COVID-19. Any mesalamine/sulfasalazine compared with no mesalamine/sulfasalazine use was associated with an increased risk (aOR 1.70, 95% CI 1.26 to 2.29). This risk estimate increased when using TNF antagonist monotherapy as a reference group (aOR 3.52, 95% CI 1.93 to 6.45). Interleukin-12/23 and integrin antagonists were not associated with significantly different risk than TNF antagonist monotherapy (aOR 0.98, 95% CI 0.12 to 8.06 and aOR 2.42, 95% CI 0.59 to 9.96, respectively). Combination therapy and thiopurines may be associated with an increased risk of severe COVID-19. No significant differences were observed when comparing classes of biologicals. These findings warrant confirmation in large population-based cohorts.MKH should be changed to MDK for co-last author line. © Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.

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