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Kumric M, Ticinovic Kurir T, Martinovic D, Zivkovic PM, Bozic J. Impact of the COVID-19 pandemic on inflammatory bowel disease patients: A review of the current evidence. World J Gastroenterol 2021; 27:3748-3761. [PMID: 34321841 PMCID: PMC8291015 DOI: 10.3748/wjg.v27.i25.3748] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 03/05/2021] [Accepted: 04/13/2021] [Indexed: 02/06/2023] Open
Abstract
Since the initial coronavirus disease 2019 (COVID-19) outbreak in China in December 2019, the infection has now become the biggest medical issue of modern medicine. Two major contributors that amplified the impact of the disease and subsequently increased the burden on health care systems were high mortality among patients with multiple co-morbidities and overcapacity of intensive care units. Within the gastroenterology-related community, particular concern was raised with respect to patients with inflammatory bowel disease (IBD), as those patients are prone to opportunistic infections mainly owing to their immunosuppressive-based therapies. Hence, we sought to summarize current knowledge regarding COVID-19 infection in patients with IBD. Overall, it seems that IBD is not a comorbidity that poses an increased risk for COVID-19 acquisition, except in patients treated with 5-aminosalicylates. Furthermore, outcomes of the infected patients are largely dependent on therapeutic modality by which they are treated, as some worsen the clinical course of COVID-19 infection, whereas others seem to dampen the detrimental effects of COVID-19. Finally, we discussed the present and the future impact of COVID-19 pandemic and concomitantly increased health care burden on IBD-management.
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Affiliation(s)
- Marko Kumric
- Department of Pathophysiology, University of Split School of Medicine, Split 21000, Croatia
| | - Tina Ticinovic Kurir
- Department of Pathophysiology, University of Split School of Medicine, Split 21000, Croatia
- Department of Endocrinology, University Hospital of Split, Split 21000, Croatia
| | - Dinko Martinovic
- Department of Pathophysiology, University of Split School of Medicine, Split 21000, Croatia
| | - Piero Marin Zivkovic
- Department of Gastroenterology, University Hospital of Split, Split 21000, Croatia
| | - Josko Bozic
- Department of Pathophysiology, University of Split School of Medicine, Split 21000, Croatia
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52
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Ouali SE, Rubin DT, Cohen BL, Regueiro MD, Rieder F. Optimal inflammatory bowel disease management during the global coronavirus disease 2019 pandemic. Curr Opin Gastroenterol 2021; 37:313-319. [PMID: 33859104 PMCID: PMC8285035 DOI: 10.1097/mog.0000000000000741] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE OF REVIEW This review aims to summarize the current evidence regarding the risks and implications of coronavirus disease 2019 (COVID-19) in patients with inflammatory bowel disease (IBD) and discuss optimal management of IBD during this pandemic. RECENT FINDINGS Patients with IBD are not at increased risk of COVID-19 but several risk factors for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 infection) have been identified, such as active IBD, obesity, and corticosteroid use. COVID-19 outcomes are similar among patients with IBD and the overall population. Although biologics have not been shown to increase the risk of severe COVID-19 complications, several risk factors have been associated with negative COVID-19 outcomes in patients with IBD, including older age, obesity, the presence of comorbidities, active disease, and corticosteroid use. IBD therapy should, therefore, be continued with the aim of attaining or maintaining remission, except for corticosteroids, which should be held or reduced to the minimal effective dose. Although it has been recommended that immunosuppressive therapy be held during a case of COVID-19, the half-lives of these drugs and data on the timing of restarting therapy limit the strength of these recommendations. We recommend COVID-19 vaccination for IBD patients whenever available, as benefits to the individual and to society outweigh the risks. SUMMARY As our understanding of SARS-CoV-2 and COVID-19 continues to evolve, we are learning more about its impact in patients with IBD and how to better manage patients in this setting. Managing IBD during this pandemic has also highlighted the importance of restructuring services in order to adapt to current and potential future outbreaks. The COVID-19 pandemic has transformed IBD care through the expansion of telemedicine and development of novel approaches to remote monitoring.
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Affiliation(s)
- Sara El Ouali
- Digestive Diseases Institute, Cleveland Clinic Abu Dhabi, United Arab Emirates
- Department of Gastroenterology, Hepatology & Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - David T. Rubin
- University of Chicago Medicine Inflammatory Bowel Disease Center, Chicago, Illinois, USA
| | - Benjamin L. Cohen
- Department of Gastroenterology, Hepatology & Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Miguel D. Regueiro
- Department of Gastroenterology, Hepatology & Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Florian Rieder
- Department of Gastroenterology, Hepatology & Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
- Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
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53
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Toyonaga T, Araba KC, Kennedy MM, Keith BP, Wolber EA, Beasley C, Steinbach EC, Schaner MR, Jain A, Long MD, Barnes EL, Herfarth HH, Isaacs KL, Hansen JJ, Kapadia MR, Guillem JG, Gulati AS, Sethupathy P, Furey TS, Ehre C, Sheikh SZ. Increased colonic expression of ACE2 associates with poor prognosis in Crohn's disease. Sci Rep 2021; 11:13533. [PMID: 34188154 PMCID: PMC8241995 DOI: 10.1038/s41598-021-92979-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 06/18/2021] [Indexed: 12/13/2022] Open
Abstract
The host receptor for SARS-CoV-2, angiotensin-converting enzyme 2 (ACE2), is highly expressed in small intestine. Our aim was to study colonic ACE2 expression in Crohn's disease (CD) and non-inflammatory bowel disease (non-IBD) controls. We hypothesized that the colonic expression levels of ACE2 impacts CD course. We examined the expression of colonic ACE2 in 67 adult CD and 14 NIBD control patients using RNA-seq and quantitative (q) RT-PCR. We validated ACE2 protein expression and localization in formalin-fixed, paraffin-embedded matched colon and ileal tissues using immunohistochemistry. The impact of increased ACE2 expression in CD for the risk of surgery was evaluated by a multivariate regression analysis and a Kaplan–Meier estimator. To provide critical support for the generality of our findings, we analyzed previously published RNA-seq data from two large independent cohorts of CD patients. Colonic ACE2 expression was significantly higher in a subset of adult CD patients which was defined as the ACE2-high CD subset. IHC in a sampling of ACE2-high CD patients confirmed high ACE2 protein expression in the colon and ileum compared to ACE2-low CD and NIBD patients. Notably, we found that ACE2-high CD patients are significantly more likely to undergo surgery within 5 years of CD diagnosis, and a Cox regression analysis found that high ACE2 levels is an independent risk factor for surgery (OR 2.17; 95% CI, 1.10–4.26; p = 0.025). Increased intestinal expression of ACE2 is associated with deteriorated clinical outcomes in CD patients. These data point to the need for molecular stratification that can impact CD disease-related outcomes.
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Affiliation(s)
- Takahiko Toyonaga
- Center for Gastrointestinal Biology and Disease, University of North Carolina At Chapel Hill, 111 Mason Farm Road, 7312B MBRB, UNC Chapel Hill, Chapel Hill, NC, 27599, USA.,Department of Gastroenterology and Hepatology, The Jikei University School of Medicine, Tokyo, Japan
| | - Kenza C Araba
- Department of Genetics, Curriculum in Bioinformatics and Computational Biology, University of North Carolina At Chapel Hill, Chapel Hill, NC, USA.,Marsico Lung Institute, University of North Carolina At Chapel Hill, Chapel Hill, NC, USA
| | - Meaghan M Kennedy
- Center for Gastrointestinal Biology and Disease, University of North Carolina At Chapel Hill, 111 Mason Farm Road, 7312B MBRB, UNC Chapel Hill, Chapel Hill, NC, 27599, USA.,Department of Genetics, Curriculum in Bioinformatics and Computational Biology, University of North Carolina At Chapel Hill, Chapel Hill, NC, USA
| | - Benjamin P Keith
- Center for Gastrointestinal Biology and Disease, University of North Carolina At Chapel Hill, 111 Mason Farm Road, 7312B MBRB, UNC Chapel Hill, Chapel Hill, NC, 27599, USA.,Department of Genetics, Curriculum in Bioinformatics and Computational Biology, University of North Carolina At Chapel Hill, Chapel Hill, NC, USA
| | - Elisabeth A Wolber
- Center for Gastrointestinal Biology and Disease, University of North Carolina At Chapel Hill, 111 Mason Farm Road, 7312B MBRB, UNC Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Caroline Beasley
- Center for Gastrointestinal Biology and Disease, University of North Carolina At Chapel Hill, 111 Mason Farm Road, 7312B MBRB, UNC Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Erin C Steinbach
- Center for Gastrointestinal Biology and Disease, University of North Carolina At Chapel Hill, 111 Mason Farm Road, 7312B MBRB, UNC Chapel Hill, Chapel Hill, NC, 27599, USA.,Division of Rheumatology, Allergy and Immunology, Department of Medicine, University of North Carolina At Chapel Hill, Chapel Hill, NC, USA
| | - Matthew R Schaner
- Center for Gastrointestinal Biology and Disease, University of North Carolina At Chapel Hill, 111 Mason Farm Road, 7312B MBRB, UNC Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Animesh Jain
- Center for Gastrointestinal Biology and Disease, University of North Carolina At Chapel Hill, 111 Mason Farm Road, 7312B MBRB, UNC Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Millie D Long
- Center for Gastrointestinal Biology and Disease, University of North Carolina At Chapel Hill, 111 Mason Farm Road, 7312B MBRB, UNC Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Edward L Barnes
- Center for Gastrointestinal Biology and Disease, University of North Carolina At Chapel Hill, 111 Mason Farm Road, 7312B MBRB, UNC Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Hans H Herfarth
- Center for Gastrointestinal Biology and Disease, University of North Carolina At Chapel Hill, 111 Mason Farm Road, 7312B MBRB, UNC Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Kim L Isaacs
- Center for Gastrointestinal Biology and Disease, University of North Carolina At Chapel Hill, 111 Mason Farm Road, 7312B MBRB, UNC Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Jonathan J Hansen
- Center for Gastrointestinal Biology and Disease, University of North Carolina At Chapel Hill, 111 Mason Farm Road, 7312B MBRB, UNC Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Muneera R Kapadia
- Department of Surgery, University of North Carolina At Chapel Hill, Chapel Hill, NC, USA
| | - José Gaston Guillem
- Department of Surgery, University of North Carolina At Chapel Hill, Chapel Hill, NC, USA
| | - Ajay S Gulati
- Center for Gastrointestinal Biology and Disease, University of North Carolina At Chapel Hill, 111 Mason Farm Road, 7312B MBRB, UNC Chapel Hill, Chapel Hill, NC, 27599, USA.,Division of Gastroenterology, Department of Pediatrics, University of North Carolina At Chapel Hill, Chapel Hill, NC, USA
| | - Praveen Sethupathy
- Department of Biomedical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, USA
| | - Terrence S Furey
- Center for Gastrointestinal Biology and Disease, University of North Carolina At Chapel Hill, 111 Mason Farm Road, 7312B MBRB, UNC Chapel Hill, Chapel Hill, NC, 27599, USA.,Department of Genetics, Curriculum in Bioinformatics and Computational Biology, University of North Carolina At Chapel Hill, Chapel Hill, NC, USA.,Department of Biology, University of North Carolina At Chapel Hill, Chapel Hill, NC, USA
| | - Camille Ehre
- Marsico Lung Institute, University of North Carolina At Chapel Hill, Chapel Hill, NC, USA
| | - Shehzad Z Sheikh
- Center for Gastrointestinal Biology and Disease, University of North Carolina At Chapel Hill, 111 Mason Farm Road, 7312B MBRB, UNC Chapel Hill, Chapel Hill, NC, 27599, USA. .,Department of Genetics, Curriculum in Bioinformatics and Computational Biology, University of North Carolina At Chapel Hill, Chapel Hill, NC, USA.
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54
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Suria C, Bosca-Watts MM, Navarro P, Tosca J, Anton R, Sanahuja A, Revaliente M, Minguez M. Management of patients with Intestinal Bowel Disease and COVID-19: A review of current evidence and future perspectives. GASTROENTEROLOGIA Y HEPATOLOGIA 2021; 45:383-389. [PMID: 34171421 PMCID: PMC8219948 DOI: 10.1016/j.gastrohep.2021.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 05/30/2021] [Accepted: 06/09/2021] [Indexed: 12/16/2022]
Abstract
The COVID-19 pandemic has been a challenge for countries and health professionals worldwide. Viral entry by ACE-2 receptor and an excessive activation of the immune system are key to understand both incidence and severity of disease. Inflammatory Bowel Disease (IBD) represents a special condition associated with an inordinate response of the immune system to external agents. IBD treatments have been associated to an increased risk of bacterial and viral infections. This has raised the question of possible higher incidence and severity of COVID-19 infection in IBD patients. Several papers have been published during this year of pandemic to answer that question. Moreover, COVID-19 vaccination offers great promise in controlling infection in patients with IBD. Based on current evidence, patients with IBD do not have a higher incidence of COVID-19 than the general population, and they do not have worse disease evolution. Advanced age and presence of a greater number of comorbidities have been associated with worse outcomes, similar to the general population. Corticosteroids are associated to an increased risk of COVID-19 infection, higher hospitalization rate and higher risk of severe COVID-19. 5-ASA/Sulfasalazine and Thiopurines have a possible increased risk of severe COVID-19, although studies are lacking. On the other hand, Anti-TNF may have a possible protective effect. It is recommended to maintain the treatment. Anti-IL-12/23, anti-integrins and tofacitinib have results comparable to anti-TNF. Based on the efficacy, expert recommendations, and the absence of other evidence, it is recommended that patients with IBD be vaccinated.
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Affiliation(s)
- Carles Suria
- Digestive Disease Department, University of Valencia, Clinic University Hospital of Valencia, Valencia 46010, Spain.
| | - Marta M Bosca-Watts
- Digestive Disease Department, University of Valencia, Clinic University Hospital of Valencia, Valencia 46010, Spain
| | - Pablo Navarro
- Digestive Disease Department, University of Valencia, Clinic University Hospital of Valencia, Valencia 46010, Spain
| | - Joan Tosca
- Digestive Disease Department, University of Valencia, Clinic University Hospital of Valencia, Valencia 46010, Spain
| | - Rosario Anton
- Digestive Disease Department, University of Valencia, Clinic University Hospital of Valencia, Valencia 46010, Spain
| | - Ana Sanahuja
- Digestive Disease Department, University of Valencia, Clinic University Hospital of Valencia, Valencia 46010, Spain
| | - Marta Revaliente
- Digestive Disease Department, University of Valencia, Clinic University Hospital of Valencia, Valencia 46010, Spain
| | - Miguel Minguez
- Digestive Disease Department, University of Valencia, Clinic University Hospital of Valencia, Valencia 46010, Spain
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55
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Bekic D, Belosic Halle Z. Inflammatory bowel disease and SARS-CoV-2 pandemic: current knowledge and recommendations. Scand J Gastroenterol 2021; 56:656-660. [PMID: 33765405 DOI: 10.1080/00365521.2021.1902561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
In the last year, we are facing a pandemic caused by SARS-CoV-2 which causes a disease called COVID-19. In everyday practice, we encounter a number of issues related to IBD patients and COVID-19. So far, we have a lot of information regarding issues of IBD patients and COVID-19, but they are scattered across numerous scientific articles. In this review, we have made a synthesis of previous knowledge regarding the main issues such as IBD patients and risk of SARS-CoV-2infection/COVID-19, outcomes of IBD patients infected with SARS-CoV-2, treatment of IBD patients in the pandemic era, endoscopy in the pandemic era, vaccination, and patient's perception and well-being during the pandemic era. The main goal of our paper is to summarize current knowledge in this literature review.
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Affiliation(s)
- Dinko Bekic
- Department of Gastroenterology and Hepatology, Internal medicine, University Hospital "Sveti Duh", Zagreb, Croatia
| | - Zeljka Belosic Halle
- Department of Gastroenterology and Hepatology, Internal medicine, University Hospital "Sveti Duh", Zagreb, Croatia
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56
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Barberio B, Buda A, Savarino EV. Should Patients With Inflammatory Bowel Disease Be Tested for Active COVID-19 Before Starting a Biological Treatment? Gastroenterology 2021; 160:2626-2627. [PMID: 32877708 PMCID: PMC7456452 DOI: 10.1053/j.gastro.2020.08.049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 07/26/2020] [Accepted: 08/25/2020] [Indexed: 12/23/2022]
Affiliation(s)
| | - Andrea Buda
- Gastroenterology Unit, Department of Gastrointestinal Oncological Surgery, S. Maria del Prato Hospital, Feltre, Italy
| | - Edoardo Vincenzo Savarino
- Division of Gastroenterology, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
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57
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Cohen RD, Feuerstein JD, Rubin DT. Reply. Gastroenterology 2021; 160:2627. [PMID: 33561439 PMCID: PMC7867470 DOI: 10.1053/j.gastro.2021.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 02/05/2021] [Indexed: 12/02/2022]
Affiliation(s)
| | | | - David T Rubin
- University of Chicago Medicine Inflammatory Bowel Disease Center, Chicago, Illinois
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58
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Should Immunosuppressive Therapy Be Modified During a Pandemic? J Neuroophthalmol 2021; 41:266-271. [PMID: 33999890 DOI: 10.1097/wno.0000000000001274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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59
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Lamb CA, Sebastian S, Kent AJ, Segal JP, Gonzalez HA, Brookes MJ, Mehta SJ, Subramanian S, Bhala N, Hicks LC, Conley TE, Patel KV, Walker GJ, Kennedy NA. Letter: risk of severe COVID-19 outcomes associated with inflammatory bowel disease medications-reassuring insights from the United Kingdom PREPARE-IBD multicentre cohort study. Aliment Pharmacol Ther 2021; 53:1236-1240. [PMID: 33961708 PMCID: PMC8207069 DOI: 10.1111/apt.16349] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
LINKED CONTENT This article is linked to Taxonera et al paper. To view this article, visit https://doi.org/10.1111/apt.15804
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60
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Weidinger C, Hegazy AN, Glauben R, Siegmund B. COVID-19-from mucosal immunology to IBD patients. Mucosal Immunol 2021; 14:566-573. [PMID: 33608656 PMCID: PMC7893623 DOI: 10.1038/s41385-021-00384-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 12/11/2020] [Accepted: 01/05/2021] [Indexed: 02/08/2023]
Abstract
Viral infections with SARS-CoV-2 can cause a multi-facetted disease, which is not only characterized by pneumonia and overwhelming systemic inflammatory immune responses, but which can also directly affect the digestive system and infect intestinal epithelial cells. Here, we review the current understanding of intestinal tropism of SARS-CoV-2 infection, its impact on mucosal function and immunology and summarize the effect of immune-suppression in patients with inflammatory bowel disease (IBD) on disease outcome of COVID-19 and discuss IBD-relevant implications for the clinical management of SARS-CoV-2 infected individuals.
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Affiliation(s)
- Carl Weidinger
- Department for Medicine (Gastroenterology, Infectious diseases, Rheumatology), Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Campus Benjamin Franklin, Berlin, Germany,Clinician Scientist Program, Berlin Institute of Health, Berlin, Germany
| | - Ahmed Nabil Hegazy
- Department for Medicine (Gastroenterology, Infectious diseases, Rheumatology), Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Campus Benjamin Franklin, Berlin, Germany,Clinician Scientist Program, Berlin Institute of Health, Berlin, Germany,Deutsches Rheumaforschungszentrum Berlin (DRFZ), An Institute of the Leibniz Association, Berlin, Germany
| | - Rainer Glauben
- Department for Medicine (Gastroenterology, Infectious diseases, Rheumatology), Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Campus Benjamin Franklin, Berlin, Germany
| | - Britta Siegmund
- Department for Medicine (Gastroenterology, Infectious diseases, Rheumatology), Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Campus Benjamin Franklin, Berlin, Germany
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61
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Agrawal M, Zhang X, Brenner EJ, Ungaro RC, Kappelman MD, Colombel JF. The Impact of Vedolizumab on COVID-19 Outcomes Among Adult IBD Patients in the SECURE-IBD Registry. J Crohns Colitis 2021; 15:1877-1884. [PMID: 33884425 PMCID: PMC8083188 DOI: 10.1093/ecco-jcc/jjab071] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND The impact of immune-modifying therapies on outcomes of coronavirus disease 2019 [COVID-19] is variable. The purpose of this study was to determine the impact of vedolizumab [VDZ], a gut-selective anti-integrin, on COVID-19 outcomes in inflammatory bowel disease [IBD] patients. METHODS Using data from the Surveillance of Coronavirus Under Research Exclusion for IBD [SECURE-IBD], an international registry of IBD patients with confirmed COVID-19, we studied the impact of VDZ on COVID-19 hospitalization and severe COVID-19 [intensive care unit stay, mechanical ventilation and/or death]. RESULTS Of 3647 adult patients on any IBD medication in the registry, 457 [12.5%] patients were on VDZ. On multivariable analyses using backward selection of covariates, VDZ use was not associated with hospitalization or severe COVID-19 when compared with patients on all other medications (adjusted odds ratio [aOR] 0.87; 95% confidence interval [CI] 0.71, 1.1 and aOR 0.95; 95% CI 0.53, 1.73, respectively). On comparing VDZ monotherapy to anti-tumour necrosis factor [anti-TNF] monotherapy, the odds for hospitalization, but not severe COVID-19, were higher [aOR CI 1.39; 95% CI 1.001, 1.90 and aOR 2.92; 95% CI 0.98, 8.71, respectively]. In an exploratory analysis, VDZ monotherapy, compared to anti-TNF monotherapy, was associated with new-onset gastrointestinal symptoms at the time of COVID-19, especially among patients whose IBD was in remission. CONCLUSIONS COVID-19 outcomes among IBD patients on VDZ are comparable to those on all other therapies. Hospitalization, but not severe COVID-19, is more likely with VDZ monotherapy than with anti-TNF monotherapy. Overall, VDZ appears to be safe in IBD patients with COVID-19.
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Affiliation(s)
- Manasi Agrawal
- The Henry D. Janowitz Division of Gastroenterology, Icahn
School of Medicine at Mount Sinai, New York,
NY, USA,Corresponding author: Manasi Agrawal, MD, The Henry D. Janowitz
Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, 1 Gustave
L. Levy Place, New York, NY 10029, USA.
| | - Xian Zhang
- Department of Pediatrics, University of North Carolina at
Chapel Hill, Chapel Hill, NC, USA
| | - Erica J Brenner
- Department of Pediatrics, University of North Carolina at
Chapel Hill, Chapel Hill, NC, USA
| | - Ryan C Ungaro
- The Henry D. Janowitz Division of Gastroenterology, Icahn
School of Medicine at Mount Sinai, New York,
NY, USA
| | - Michael D Kappelman
- Department of Pediatrics, University of North Carolina at
Chapel Hill, Chapel Hill, NC, USA
| | - Jean-Frederic Colombel
- The Henry D. Janowitz Division of Gastroenterology, Icahn
School of Medicine at Mount Sinai, New York,
NY, USA
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Farkas K, Pigniczki D, Rutka M, Szántó KJ, Resál T, Bor R, Fábián A, Szepes Z, Lázár G, Molnár T. The complex relationship between viruses and inflammatory bowel disease - review and practical advices for the daily clinical decision-making during the SARS-CoV-2 pandemic. Therap Adv Gastroenterol 2021; 14:1756284820988198. [PMID: 33953797 PMCID: PMC8044573 DOI: 10.1177/1756284820988198] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 12/26/2020] [Indexed: 02/04/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) outbreak emerged in December 2019 in China and rapidly spread worldwide. Inflammatory bowel disease (IBD) patients are likely to be more susceptible to viral infections, and this is significantly influenced by the type of therapy they receive. Thus, issues specifically concerning the medical treatment of IBD patients were shortly addressed at the beginning of the pandemic. However, recently available data on the occurrence and outcome of SARS-CoV-2 infection in IBD patients does not address the concerns raised at the beginning of the pandemic. Growing evidence and the rapid changes happening over the past few weeks have helped elucidate the current situation, contribute to our understanding of the disease, and many previously raised questions could now be answered. We hereby summarise available evidence regarding viral infections and IBD, focusing on SARS-CoV infections, and we provide practical recommendations related to patient management during the COVID-19 pandemic era.
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Affiliation(s)
- Klaudia Farkas
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | | | - Mariann Rutka
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | | | - Tamás Resál
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Renáta Bor
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Anna Fábián
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Zoltán Szepes
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - György Lázár
- Department of Surgery, University of Szeged, Szeged, Hungary
| | - Tamás Molnár
- First Department of Medicine, University of Szeged. 8-10 Korányi Alley, Szeged, H6720, Hungary
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63
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Derikx LAAP, Lantinga MA, de Jong DJ, van Dop WA, Creemers RH, Römkens TEH, Jansen JM, Mahmmod N, West RL, Tan ACITL, Bodelier AGL, Gorter MHP, Boekema PJ, Halet ERC, Horjus CS, van Dijk MA, Hirdes MMC, Epping Stippel LSM, Jharap B, Lutgens MWMD, Russel MG, Gilissen LPL, Nauta S, van Bodegraven AA, Hoentjen F. Clinical Outcomes of Covid-19 in Patients With Inflammatory Bowel Disease: A Nationwide Cohort Study. J Crohns Colitis 2021; 15:529-539. [PMID: 33079178 PMCID: PMC7665430 DOI: 10.1093/ecco-jcc/jjaa215] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND AIMS The COVID-19 risk and disease course in inflammatory bowel disease [IBD] patients remains uncertain. Therefore, we aimed to assess the clinical presentation, disease course, and outcomes of COVID-19 in IBD patients. Second, we determined COVID-19 incidences in IBD patients and compared this with the general population. METHODS We conducted a multicentre, nationwide IBD cohort study in The Netherlands and identified patients with COVID-19. First, we assessed the COVID-19 disease course and outcomes. Second, we compared COVID-19 incidences between our IBD study cohort and the general Dutch population. RESULTS We established an IBD cohort of 34 763 patients. COVID-19 was diagnosed in 100/34 763 patients [0.29%]; 20/100 of these patients [20%] had severe COVID-19 defined as admission to the intensive care unit, mechanical ventilation, and/or death. Hospitalisation occurred in 59/100 [59.0%] patients and 13/100 [13.0%] died. All patients who died had comorbidities and all but one were ≥65 years old. In line, we identified ≥1 comorbidity as an independent risk factor for hospitalisation (odds ratio [OR] 4.20, 95% confidence interval [CI] 1.58-11.17,; p = 0.004). Incidences of COVID-19 between the IBD study cohort and the general population were comparable (287.6 [95% CI 236.6-349.7] versus 333.0 [95% CI 329.3-336.7] per 100000 patients, respectively; p = 0.15). CONCLUSIONS Of 100 cases with IBD and COVID-19, 20% developed severe COVID-19, 59% were hospitalised and 13% died. A comparable COVID-19 risk was found between the IBD cohort [100/34 763 = 0.29%] and the general Dutch population. The presence of ≥1 comorbidities was an independent risk factor for hospitalisation due to COVID-19.
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Affiliation(s)
- Lauranne A A P Derikx
- Department of Gastroenterology and Hepatology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Marten A Lantinga
- Department of Gastroenterology and Hepatology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Dirk J de Jong
- Department of Gastroenterology and Hepatology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Willemijn A van Dop
- Department of Gastroenterology and Hepatology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Rob H Creemers
- Zuyderland Medical Centre, Department of Gastroenterology, Geriatrics, Internal and Intensive Care Medicine (Co-MIK), Sittard-Geleen, The Netherlands
| | - Tessa E H Römkens
- Department of Gastroenterology and Hepatology, Jeroen Bosch Hospital, ‘s-Hertogenbosch, The Netherlands
| | - Jeroen M Jansen
- Department of Gastroenterology and Hepatology, Onze Lieve Vrouwe Gasthuis Amsterdam, Amsterdam, The Netherlands
| | - Nofel Mahmmod
- Department of Gastroenterology and Hepatology, St Antonius Hospital Nieuwegein, Nieuwegein, The Netherlands
| | - Rachel L West
- Department of Gastroenterology and Hepatology, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
| | - Adriaan C I T L Tan
- Department of Gastroenterology and Hepatology, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
| | | | - Moniek H P Gorter
- Department of Gastroenterology and Hepatology, Bernhoven Hospital, Uden, The Netherlands
| | - Paul J Boekema
- Department of Gastroenterology and Hepatology, Maxima Medical Centre, Eindhoven, The Netherlands
| | - Eric R C Halet
- Department of Gastroenterology and Hepatology, Bravis Hospital, Roosendaal, The Netherlands
| | - Carmen S Horjus
- Department of Gastroenterology and Hepatology, Rijnstate Hospital, Arnhem, The Netherlands
| | - Maarten A van Dijk
- Department of Gastroenterology and Hepatology, Stichting Elkerliek Hospital, Helmond, The Netherlands
| | - Meike M C Hirdes
- Department of Gastroenterology and Hepatology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | | | - Bindia Jharap
- Department of Gastroenterology, Meander Medical Centre, Amersfoort, The Netherlands
| | - Maurice W M D Lutgens
- Department of Gastroenterology and Hepatology, Elisabeth – Tweesteden Hospital, Tilburg, The Netherlands
| | - Maurice G Russel
- Department of Gastroenterology and Hepatology, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Lennard P L Gilissen
- Department of Gastroenterology and Hepatology, Catharina Hospital, Eindhoven, The Netherlands
| | - Sjoukje Nauta
- Department of Gastroenterology, Slingeland Hospital, Doetinchem, The Netherlands
| | - Adriaan A van Bodegraven
- Zuyderland Medical Centre, Department of Gastroenterology, Geriatrics, Internal and Intensive Care Medicine (Co-MIK), Sittard-Geleen, The Netherlands
- Department of Gastroenterology and Hepatology, Amsterdam UMC -‐Location VUMC, Amsterdam, The Netherlands
| | - Frank Hoentjen
- Department of Gastroenterology and Hepatology, Radboud University Medical Centre, Nijmegen, The Netherlands
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Li J, Liu HH, Yin XD, Li CC, Wang J. COVID-19 illness and autoimmune diseases: recent insights. Inflamm Res 2021; 70:407-428. [PMID: 33640999 PMCID: PMC7914392 DOI: 10.1007/s00011-021-01446-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 01/25/2021] [Accepted: 02/18/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The aim of this review is to explore whether patients with autoimmune diseases (AIDs) were at high risk of infection during the COVID-19 epidemic and how severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic affected immune system. METHODS A systematic literature search was performed using the foreign databases (NCBI, web of science, EBSCO, ELSEVIER ScienceDirect) and Chinese databases (WanFang, CNKI (China National Knowledge Infrastructure), VIP, CBM) to locate all relevant publications (up to January 10, 2021). The search strategies used Medical Search Headings (MeSH) headings and keywords for "COVID-19" or "SARS-CoV-2" or "coronavirus" and "autoimmune disease". RESULTS This review evaluates the effect of SARS-CoV-2 on the immune system through ACE-2 receptor binding as the main pathway for cell attachment and invasion. It is speculated that SARS-COV-2 infection can activate lymphocytes and inflammatory response, which may play a role in the clinical onset of AIDs and also patients were treated with immunomodulatory drugs during COVID-19 outbreak. Preliminary studies suggested that the risk of developing severe forms of COVID-19 in patients with AIDs treated with immunomodulators or biologics might not increase. A large number of samples are needed for further verification, leading to an excessive immune response to external stimuli. CONCLUSION The relationship between autoimmune diseases and SARS-CoV-2 infection is complex. During the COVID-19 epidemic, individualized interventions for AIDs should be provided such as Internet-based service.
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Affiliation(s)
- Juan Li
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Meishan Road 81, Hefei, 230032, Anhui, People's Republic of China
- Medical Data Processing Center of School of Public Health of Anhui Medical University, Anhui Medical University, Hefei, China
| | - Hong-Hui Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Meishan Road 81, Hefei, 230032, Anhui, People's Republic of China
- Medical Data Processing Center of School of Public Health of Anhui Medical University, Anhui Medical University, Hefei, China
| | - Xiao-Dong Yin
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Meishan Road 81, Hefei, 230032, Anhui, People's Republic of China
- Medical Data Processing Center of School of Public Health of Anhui Medical University, Anhui Medical University, Hefei, China
| | - Cheng-Cheng Li
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Meishan Road 81, Hefei, 230032, Anhui, People's Republic of China
- Medical Data Processing Center of School of Public Health of Anhui Medical University, Anhui Medical University, Hefei, China
| | - Jing Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Meishan Road 81, Hefei, 230032, Anhui, People's Republic of China.
- Medical Data Processing Center of School of Public Health of Anhui Medical University, Anhui Medical University, Hefei, China.
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Are Patients With Inflammatory Bowel Disease at an Increased Risk of Developing SARS-CoV-2 than Patients Without Inflammatory Bowel Disease? Results From a Nationwide Veterans' Affairs Cohort Study. Am J Gastroenterol 2021; 116:808-810. [PMID: 33982951 DOI: 10.14309/ajg.0000000000001012] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION The clinic course of SARS-CoV-2 among patients with inflammatory bowel disease (IBD) has been extensively studied. However, there is a paucity of data on whether patients with IBD have an increased risk of developing SARS-CoV-2 with compared with patients without IBD. METHODS We conducted a nationwide retrospective cohort study in the US Veterans' Affairs healthcare system from January 1, 2020, to June 30, 2020. We matched each patient with IBD with 2 patients without IBD on age, sex, race, location, and comorbidities. The outcome of interest was development of SARS-CoV-2. RESULTS Among 38,378 patients with IBD and 67,433 patients without IBD, 87 (0.23%) and 132 (0.20%) patients developed incident SARS-CoV-2 infection, respectively (P = 0.29). DISCUSSION Patients with IBD are not at a significantly increased risk of developing SARS-CoV-2 infection when compared with patients without IBD.
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Assessment, endoscopy, and treatment in patients with acute severe ulcerative colitis during the COVID-19 pandemic (PROTECT-ASUC): a multicentre, observational, case-control study. Lancet Gastroenterol Hepatol 2021; 6:271-281. [PMID: 33545083 PMCID: PMC7906670 DOI: 10.1016/s2468-1253(21)00016-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 12/23/2020] [Accepted: 12/23/2020] [Indexed: 01/12/2023]
Abstract
BACKGROUND There is a paucity of evidence to support safe and effective management of patients with acute severe ulcerative colitis during the COVID-19 pandemic. We sought to identify alterations to established conventional evidence-based management of acute severe ulcerative colitis during the early COVID-19 pandemic, the effect on outcomes, and any associations with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and severe COVID-19 outcomes. METHODS The PROTECT-ASUC study was a multicentre, observational, case-control study in 60 acute secondary care hospitals throughout the UK. We included adults (≥18 years) with either ulcerative colitis or inflammatory bowel disease unclassified, who presented with acute severe ulcerative colitis and fulfilled the Truelove and Witts criteria. Cases and controls were identified as either admitted or managed in emergency ambulatory care settings between March 1, 2020, and June 30, 2020 (COVID-19 pandemic period cohort), or between Jan 1, 2019, and June 30, 2019 (historical control cohort), respectively. The primary outcome was the proportion of patients with acute severe ulcerative colitis receiving rescue therapy (including primary induction) or colectomy. The study is registered with ClinicalTrials.gov, NCT04411784. FINDINGS We included 782 patients (398 in the pandemic period cohort and 384 in the historical control cohort) who met the Truelove and Witts criteria for acute severe ulcerative colitis. The proportion of patients receiving rescue therapy (including primary induction) or surgery was higher during the pandemic period than in the historical period (217 [55%] of 393 patients vs 159 [42%] of 380 patients; p=0·00024) and the time to rescue therapy was shorter in the pandemic cohort than in the historical cohort (p=0·0026). This difference was driven by a greater use of rescue and primary induction therapies with biologicals, ciclosporin, or tofacitinib in the COVID-19 pandemic period cohort than in the historical control period cohort (177 [46%] of 387 patients in the COVID-19 cohort vs 134 [36%] of 373 patients in the historical cohort; p=0·0064). During the pandemic, more patients received ambulatory (outpatient) intravenous steroids (51 [13%] of 385 patients vs 19 [5%] of 360 patients; p=0·00023). Fewer patients received thiopurines (29 [7%] of 398 patients vs 46 [12%] of 384; p=0·029) and 5-aminosalicylic acids (67 [17%] of 398 patients vs 98 [26%] of 384; p=0·0037) during the pandemic than in the historical control period. Colectomy rates were similar between the pandemic and historical control groups (64 [16%] of 389 vs 50 [13%] of 375; p=0·26); however, laparoscopic surgery was less frequently performed during the pandemic period (34 [53%] of 64] vs 38 [76%] of 50; p=0·018). Five (2%) of 253 patients tested positive for SARS-CoV-2 during hospital treatment. Two (2%) of 103 patients re-tested for SARS-CoV-2 during the 3-month follow-up were positive 5 days and 12 days, respectively, after discharge from index admission. Both recovered without serious outcomes. INTERPRETATION The COVID-19 pandemic altered practice patterns of gastroenterologists and colorectal surgeons in the management of acute severe ulcerative colitis but was associated with similar outcomes to a historical cohort. Despite continued use of high-dose corticosteroids and biologicals, the incidence of COVID-19 within 3 months was low and not associated with adverse COVID-19 outcomes. FUNDING None.
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Reuken PA, Teich N, Stallmach A. Safety of Tofacitinib in the COVID-19 Pandemic-Enough Is Not Enough. Inflamm Bowel Dis 2021; 27:e89. [PMID: 33783508 PMCID: PMC8083615 DOI: 10.1093/ibd/izab051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Affiliation(s)
- Philipp A Reuken
- Department of Internal Medicine IV, Jena University Hospital, Jena, Germany,Address correspondence to: Philipp A. Reuken, PD, Universitätsklinikum Jena, Klinik für Innere Medizin IV—Gastroenterologie, Hepatologie, Infektiologie, Am Klinikum 1, 07747 Jena, Germany ()
| | - Niels Teich
- Internistische Gemeinschaftspraxis für Verdauungs und Stoffwechselkrankheiten Leipzig und Schkeuditz, Leipzig, Germany
| | - Andreas Stallmach
- Department of Internal Medicine IV, Jena University Hospital, Jena, Germany
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Singh AK, Jena A, Kumar-M P, Sharma V, Sebastian S. Risk and outcomes of coronavirus disease in patients with inflammatory bowel disease: A systematic review and meta-analysis. United European Gastroenterol J 2021; 9:159-176. [PMID: 33210980 PMCID: PMC8250629 DOI: 10.1177/2050640620972602] [Citation(s) in RCA: 84] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 10/14/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The risk of severe acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2) infection and clinical outcomes of coronavirus disease (COVID-19) in inflammatory bowel disease are unclear. METHODS We searched PubMed and Embase with the keywords: inflammatory bowel disease, Crohn's disease, ulcerative colitis and COVID-19, novel coronavirus and SARS-CoV-2. We included studies reporting the frequency of COVID-19 infection and outcomes (hospitalisation, need for intensive care unit care and mortality) in patients with inflammatory bowel disease. We estimated the pooled incidence of COVID-19 in inflammatory bowel disease and comparative risk vis-a-vis the general population. We also estimated the pooled frequency of outcomes and compared them in patients who received and did not receive drugs for inflammatory bowel disease. RESULTS Twenty-four studies were included. The pooled incidence rate of COVID-19 per 1000 patients of inflammatory bowel disease and the general population were 4.02 (95% confidence interval [CI, 1.44-11.17]) and 6.59 [3.25-13.35], respectively, with no increase in relative risk (0.47, 0.18-1.26) in inflammatory bowel disease. The relative risk of the acquisition of COVID-19 was not different between ulcerative colitis and Crohn's disease (1.03, 0.62-1.71). The pooled proportion of COVID-19-positive inflammatory bowel disease patients requiring hospitalisation and intensive care unit care was 27.29% and 5.33% while pooled mortality was 4.27%. The risk of adverse outcomes was higher in ulcerative colitis compared to Crohn's disease. The relative risks of hospitalisation, intensive care unit admission and mortality were lower for patients on biological agents (0.34, 0.19-0.61; 0.49, 0.33-0.72 and 0.22, 0.13-0.38, respectively) but higher with steroids (1.99, 1.64-2.40; 3.41, 2.28-5.11 and 2.70, 1.61-4.55) or 5-aminosalicylate (1.59, 1.39-1.82; 2.38, 1.26-4.48 and 2.62, 1.67-4.11) use. CONCLUSION SARS-CoV-2 infection risk in patients with inflammatory bowel disease is comparable to the general population. Outcomes of COVID-19-positive inflammatory bowel disease patients are worse in ulcerative colitis, those on steroids or 5-aminosalicylates but outcomes are better with biological agents.
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Affiliation(s)
- Anupam Kumar Singh
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Anuraag Jena
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Praveen Kumar-M
- Department of Pharmacology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vishal Sharma
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Maconi G, Bosetti C, De Monti A, Boyapati RK, Shelton E, Piazza N, Carvalhas Gabrielli AM, Lenti MV, Bezzio C, Ricci C, Greco S, Romeo S, Giangregorio F, Gridavilla D, Tagliani F, Massari A, Pastorelli L, Di Sabatino A, Saibeni S, Alicante S, Ferretti F, Rizzardini G, Galli M, Ardizzone S. Risk of COVID 19 in patients with inflammatory bowel diseases compared to a control population. Dig Liver Dis 2021; 53:263-270. [PMID: 33483259 PMCID: PMC7762705 DOI: 10.1016/j.dld.2020.12.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 12/12/2020] [Accepted: 12/15/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND It is unclear whether patients with inflammatory bowel disease (IBD) are at increased risk of COVID-19. OBJECTIVES This observational study compared the prevalence of COVID-19 symptoms, diagnosis and hospitalization in IBD patients with a control population with non-inflammatory bowel disorders. METHODS This multicentre study, included 2733 outpatients (1397 IBD patients and 1336 controls), from eight major gastrointestinal centres in Lombardy, Italy. Patients were invited to complete a web-based questionnaire regarding demographic, historical and clinical features over the previous 6 weeks. The prevalence of COVID-19 symptoms, diagnosis and hospitalization for COVID-19 was assessed. RESULTS 1810 patients (64%) responded to the questionnaire (941 IBD patients and 869 controls). IBD patients were significantly younger and of male sex than controls. NSAID use and smoking were more frequent in controls. IBD patients were more likely treated with vitamin-D and vaccinated for influenza. Highly probable COVID-19 on the basis of symptoms and signs was less frequent in the IBD group (3.8% vs 6.3%; OR:0.45, 95%CI:0.28-0.75). IBD patients had a lower rate of nasopharyngeal swab-PCR confirmed diagnosis (0.2% vs 1.2%; OR:0.14, 95%CI:0.03-0.67). There was no difference in hospitalization between the groups (0.1% vs 0.6%; OR:0.14, 95%CI:0.02-1.17). CONCLUSION IBD patients do not have an increased risk of COVID-19 specific symptoms or more severe disease compared with a control group of gastroenterology patients.
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Affiliation(s)
- Giovanni Maconi
- Gastroenterology Unit, ASST Fatebenefratelli Sacco, Department of Biomedical and Clinical Sciences "L.Sacco" University of Milan, Italy.
| | - Cristina Bosetti
- Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Alberta De Monti
- Gastroenterology Unit, ASST Fatebenefratelli Sacco, Department of Biomedical and Clinical Sciences "L.Sacco" University of Milan, Italy
| | - Ray Kiran Boyapati
- Department of Gastroenterology, Monash Health. Faculty of Medicine, Nursing & Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Edward Shelton
- Department of Gastroenterology, Monash Health. Faculty of Medicine, Nursing & Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Nicole Piazza
- Gastroenterology Unit, IRCCS Policlinico San Donato, San Donato Milanese, Italy; Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Anna Maria Carvalhas Gabrielli
- Gastroenterology Unit, ASST Fatebenefratelli Sacco, Department of Biomedical and Clinical Sciences "L.Sacco" University of Milan, Italy
| | - Marco Vincenzo Lenti
- Department of Internal Medicine, Fondazione IRCCS Policlinico San Matteo, Università degli Studi di Pavia, Pavia, Lombardia, Italy
| | - Cristina Bezzio
- Gastroenterology Unit, Rho Hospital, Rho (MI), ASST Rhodense, Garbagnate Milanese, Italy
| | - Chiara Ricci
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy; Division of Gastroenterology, ASST Spedali Civili, Brescia, Italy
| | - Salvatore Greco
- Papa Giovanni XXIII Hospital, Gastroenterology and Digestive Endoscopy Units, Bergamo, Italy
| | - Samanta Romeo
- Department of Gastroenterology and Endoscopy, Maggiore Hospital, ASST Crema, Crema, Italy
| | | | - Daniele Gridavilla
- Gastroenterology Unit, ASST Fatebenefratelli Sacco, Department of Biomedical and Clinical Sciences "L.Sacco" University of Milan, Italy
| | - Fabio Tagliani
- Gastroenterology Unit, ASST Fatebenefratelli Sacco, Department of Biomedical and Clinical Sciences "L.Sacco" University of Milan, Italy
| | - Alessandro Massari
- Gastroenterology Unit, ASST Fatebenefratelli Sacco, Department of Biomedical and Clinical Sciences "L.Sacco" University of Milan, Italy
| | - Luca Pastorelli
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Antonio Di Sabatino
- Department of Internal Medicine, Fondazione IRCCS Policlinico San Matteo, Università degli Studi di Pavia, Pavia, Lombardia, Italy
| | - Simone Saibeni
- Gastroenterology Unit, Rho Hospital, Rho (MI), ASST Rhodense, Garbagnate Milanese, Italy
| | - Saverio Alicante
- Department of Gastroenterology and Endoscopy, Maggiore Hospital, ASST Crema, Crema, Italy
| | - Francesca Ferretti
- Gastroenterology Unit, ASST Fatebenefratelli Sacco, Department of Biomedical and Clinical Sciences "L.Sacco" University of Milan, Italy
| | - Giuliano Rizzardini
- I Division of Infectious Diseases, ASST Fatebenefratelli-Sacco, L. Sacco Hospital, Milan, Italy
| | - Massimo Galli
- III Division of Infectious Diseases, ASST Fatebenefratelli-Sacco, Department of Biomedical and Clinical Sciences, University of Milan, Italy
| | - Sandro Ardizzone
- Gastroenterology Unit, ASST Fatebenefratelli Sacco, Department of Biomedical and Clinical Sciences "L.Sacco" University of Milan, Italy
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Akiyama S, Hamdeh S, Micic D, Sakuraba A. Prevalence and clinical outcomes of COVID-19 in patients with autoimmune diseases: a systematic review and meta-analysis. Ann Rheum Dis 2021; 80:384-391. [PMID: 33051220 PMCID: PMC7554412 DOI: 10.1136/annrheumdis-2020-218946] [Citation(s) in RCA: 218] [Impact Index Per Article: 72.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 09/30/2020] [Accepted: 09/30/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVES The prevalence and clinical outcomes of COVID-19 in patients with autoimmune diseases who are frequently treated with disease modifying therapies remains poorly understood. This meta-analysis aims to assess the prevalence and clinical outcomes of COVID-19 in autoimmune diseases. METHODS Electronic databases were searched for observational and case-controlled studies. We sorted medications into glucocorticoids, conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) and biologic or targeted synthetic DMARDs (b/tsDMARDs), which was also divided into monotherapy and b/tsDMARDs-csDMARDs combination therapy. RESULTS We analysed 62 observational studies with a total of 319 025 patients with autoimmune diseases. The prevalence of COVID-19 was 0.011 (95% CI: 0.005 to 0.025). Meta-analysis of seven case-controlled studies demonstrated that the risk of COVID-19 in autoimmune diseases was significantly higher than in control patients (OR: 2.19, 95% CI: 1.05 to 4.58, p=0.038). Meta-regression analysis showed glucocorticoids were significantly associated with the risk of COVID-19. For clinical outcomes, we assessed 65 studies with 2766 patients with autoimmune diseases diagnosed with COVID-19. The rates of hospitalisation and mortality were 0.35 (95% CI: 0.23 to 0.50) and 0.066 (95% CI: 0.036 to 0.12), respectively. Glucocorticoids, csDMARDs and b/tsDMARDs-csDMARDs combination therapy increased the risk of these outcomes, whereas b/tsDMARDs monotherapy, particularly antitumour necrosis factor agents, were associated with a lower risk of hospitalisation and death. CONCLUSIONS Our meta-analysis demonstrated that patients with autoimmune diseases had an increased risk of COVID-19, primarily attributed to glucocorticoid use. b/tsDMARDs monotherapy was associated with a lower risk of severe COVID-19 suggesting its safety in the COVID-19 pandemic.
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Affiliation(s)
- Shintaro Akiyama
- Inflammatory Bowel Disease Center, The University of Chicago Medicine, Chicago, Illinois, USA
| | - Shadi Hamdeh
- Department of Internal Medicine, Division of Gastroenterology, Hepatology and Motility, University of Kansas, Lawrence, Kansas, USA
| | - Dejan Micic
- Inflammatory Bowel Disease Center, The University of Chicago Medicine, Chicago, Illinois, USA
| | - Atsushi Sakuraba
- Inflammatory Bowel Disease Center, The University of Chicago Medicine, Chicago, Illinois, USA
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Rizzello F, Calabrese C, Salice M, Calandrini L, Privitera H, Melotti L, Peruzzi G, Dussias N, Belluzzi A, Scaioli E, Decorato A, Siniscalchi A, Filippone E, Laureti S, Rottoli M, Poggioli G, Gionchetti P. COVID-19 in IBD: The experience of a single tertiary IBD center. Dig Liver Dis 2021; 53:271-276. [PMID: 33451910 PMCID: PMC7764386 DOI: 10.1016/j.dld.2020.12.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 12/16/2020] [Accepted: 12/18/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Italy has been one of the most affected countries in the world by COVID-19. There has been increasing concern regarding the impact of COVID-19 on patients with inflammatory bowel disease (IBD), particularly in patients treated with immunosuppressants or biologics. The aim of our study is to understand the incidence of COVID-19 in a large cohort of patients with IBD. Furthermore, we analyzed possible risk factors for infection and severity of COVID-19. METHODS This was an observational study evaluating the impact of COVID-19 on IBD patients in a single tertiary center. A 23 multiple-choice-question anonymous survey was administered to 1200 patients with IBD between March 10th and June 10th 2020. RESULTS 1158 questionnaires were analyzed. The majority of patients had Crohn's disease (CD) (60%) and most of them were in clinical remission. Among the 26 patients (2.2%) who tested positive for COVID-19, only 5 (3CD) were on biological treatment and none required hospitalization. Two patients died and were on treatment with mesalazine only. Of the 1158 patients, 521 were on biological therapy, which was discontinued in 85 (16.3%) and delayed in 195 patients (37.4%). A worsening of IBD symptoms was observed in 200 patients on biological therapy (38.4%). Most of these patients, 189 (94.5%), had stopped or delayed biological treatment, while 11 (5.5%) had continued their therapy regularly (p<0.001). CONCLUSIONS Our data are in line with the current literature and confirm a higher incidence compared to the general population. Biological therapy for IBD seems to not be a risk factor for infection and should not be discontinued in order to avoid IBD relapse.
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Affiliation(s)
- Fernando Rizzello
- Centro di Riferimento Regionale Malattie Infiammatorie Croniche Intestinali, DIMEC Azienda Ospedaliero-Universitaria Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | - Carlo Calabrese
- Centro di Riferimento Regionale Malattie Infiammatorie Croniche Intestinali, DIMEC Azienda Ospedaliero-Universitaria Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | - Marco Salice
- Centro di Riferimento Regionale Malattie Infiammatorie Croniche Intestinali, DIMEC Azienda Ospedaliero-Universitaria Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | - Lucia Calandrini
- Centro di Riferimento Regionale Malattie Infiammatorie Croniche Intestinali, DIMEC Azienda Ospedaliero-Universitaria Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | - Hana Privitera
- Centro di Riferimento Regionale Malattie Infiammatorie Croniche Intestinali, DIMEC Azienda Ospedaliero-Universitaria Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | - Laura Melotti
- Centro di Riferimento Regionale Malattie Infiammatorie Croniche Intestinali, DIMEC Azienda Ospedaliero-Universitaria Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | - Giulia Peruzzi
- Centro di Riferimento Regionale Malattie Infiammatorie Croniche Intestinali, DIMEC Azienda Ospedaliero-Universitaria Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | - Nikolas Dussias
- Centro di Riferimento Regionale Malattie Infiammatorie Croniche Intestinali, DIMEC Azienda Ospedaliero-Universitaria Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | - Andrea Belluzzi
- Centro di Riferimento Regionale Malattie Infiammatorie Croniche Intestinali, DIMEC Azienda Ospedaliero-Universitaria Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | - Eleonora Scaioli
- Centro di Riferimento Regionale Malattie Infiammatorie Croniche Intestinali, DIMEC Azienda Ospedaliero-Universitaria Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | - Anastasio Decorato
- Centro di Riferimento Regionale Malattie Infiammatorie Croniche Intestinali, DIMEC Azienda Ospedaliero-Universitaria Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | - Antonio Siniscalchi
- Centro di Riferimento Regionale Malattie Infiammatorie Croniche Intestinali, DIMEC Azienda Ospedaliero-Universitaria Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | - Eleonora Filippone
- Centro di Riferimento Regionale Malattie Infiammatorie Croniche Intestinali, DIMEC Azienda Ospedaliero-Universitaria Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | - Silvio Laureti
- Centro di Riferimento Regionale Malattie Infiammatorie Croniche Intestinali, DIMEC Azienda Ospedaliero-Universitaria Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | - Matteo Rottoli
- Centro di Riferimento Regionale Malattie Infiammatorie Croniche Intestinali, DIMEC Azienda Ospedaliero-Universitaria Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | - Gilberto Poggioli
- Centro di Riferimento Regionale Malattie Infiammatorie Croniche Intestinali, DIMEC Azienda Ospedaliero-Universitaria Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | - Paolo Gionchetti
- Centro di Riferimento Regionale Malattie Infiammatorie Croniche Intestinali, DIMEC Azienda Ospedaliero-Universitaria Policlinico Sant'Orsola-Malpighi, Bologna, Italy.
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Ludvigsson JF, Axelrad J, Halfvarson J, Khalili H, Larsson E, Lochhead P, Roelstraete B, Simon TG, Söderling J, Olén O. Inflammatory bowel disease and risk of severe COVID-19: A nationwide population-based cohort study in Sweden. United European Gastroenterol J 2021; 9:177-192. [PMID: 33704918 PMCID: PMC8014882 DOI: 10.1002/ueg2.12049] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND There are concerns that individuals with chronic immune-mediated diseases are at increased risk of COVID-19 and related severe adverse outcome, including intensive care admission or death. We aimed to explore the absolute and relative risk of severe COVID-19 in inflammatory bowel disease (IBD). METHODS This population-based cohort study used nationwide registers in Sweden, with 67,292 individuals with a diagnosis of IBD 1969-2017 (Crohn's disease, n = 21,599; ulcerative colitis: n = 43,622; IBD-unclassified: n = 2071) and alive on 1 February 2020. Patients with IBD were matched to up to five controls from the general population (n = 297,910). Cox regression estimated hazard ratios (HRs) for (i) hospital admission with laboratory-confirmed COVID-19 as the primary diagnosis, and (ii) severe COVID-19 (composite outcome consisting of (a) COVID-19 intensive care admission, or (b) death from COVID-19 or (c) death within 30 days of COVID-19 hospital admission), were calculated. Analyses were conditioned on age, sex, calendar period, and county and adjusted for other comorbidities. RESULTS Between 1 February and 31 July 2020, 179 (0.27%) IBD patients and 500 (0.17%) general population controls were admitted to hospital with COVID-19 (adjusted HR [aHR] = 1.43; 95% CI = 1.19-1.72). The corresponding numbers for severe COVID-19 was 65 (0.10%) and 183 (0.06%; aHR = 1.11; 95% CI = 0.81-1.52). Adjusted HRs were similar in Crohn's disease and ulcerative colitis. In a propensity score-matched model taking comorbidity into account until 2016, the increased risk for COVID-19 hospital admission remained (aHR = 1.32; 1.12-1.56), but there was no increased risk of severe COVID-19 (aHR = 1.12; 0.85-1.47). CONCLUSIONS While individuals with IBD were more likely to be admitted to hospital for COVID-19 than the general population, the risk of severe COVID-19 was not higher.
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Affiliation(s)
- Jonas F. Ludvigsson
- Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetStockholmSweden
- Department of PaediatricsÖrebro University HospitalÖrebroSweden
- Division of Epidemiology and Public HealthSchool of MedicineUniversity of NottinghamNottinghamUK
- Department of MedicineCeliac Disease CenterColumbia University College of Physicians and SurgeonsNew YorkNew YorkUSA
| | - Jordan Axelrad
- Division of GastroenterologyDepartment of MedicineNYU Grossman School of MedicineNew YorkNew YorkUSA
| | - Jonas Halfvarson
- Department of GastroenterologyFaculty of Medicine and HealthÖrebro UniversityÖrebroSweden
| | - Hamed Khalili
- Clinical and Translational Epidemiology Unit and Division of GastroenterologyMassachusetts General HospitalBostonMassachusettsUSA
| | - Emma Larsson
- Department of Physiology and PharmacologyKarolinska InstitutetStockholmSweden
- Perioperative Medicine and Intensive CareKarolinska University HospitalStockholmSweden
| | - Paul Lochhead
- Clinical and Translational Epidemiology Unit and Division of GastroenterologyMassachusetts General HospitalBostonMassachusettsUSA
| | - Bjorn Roelstraete
- Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetStockholmSweden
| | - Tracey G. Simon
- Clinical and Translational Epidemiology Unit and Division of GastroenterologyMassachusetts General HospitalBostonMassachusettsUSA
| | - Jonas Söderling
- Clinical Epidemiology DivisionDepartment of Medicine SolnaKarolinska InstitutetStockholmSweden
| | - Ola Olén
- Clinical Epidemiology DivisionDepartment of Medicine SolnaKarolinska InstitutetStockholmSweden
- Sachs' Children and Youth HospitalStockholm South General HospitalStockholmSweden
- Department of Clinical Science and Education SödersjukhusetKarolinska InstitutetStockholmSweden
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Hanson KE, Caliendo AM, Arias CA, Hayden MK, Englund JA, Lee MJ, Loeb M, Patel R, El Alayli A, Altayar O, Patel P, Falck-Ytter Y, Lavergne V, Morgan RL, Murad MH, Sultan S, Bhimraj A, Mustafa RA. The Infectious Diseases Society of America Guidelines on the Diagnosis of COVID-19: Molecular Diagnostic Testing. Clin Infect Dis 2021:ciab048. [PMID: 33480973 PMCID: PMC7929045 DOI: 10.1093/cid/ciab048] [Citation(s) in RCA: 98] [Impact Index Per Article: 32.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Accurate molecular diagnostic tests are necessary for confirming a diagnosis of coronavirus disease 2019 (COVID-19). Direct detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) nucleic acids in respiratory tract specimens informs patient, healthcare institution and public health level decision-making. The numbers of available SARS-CoV-2 nucleic acid detection tests are rapidly increasing, as is the COVID-19 diagnostic literature. Thus, the Infectious Diseases Society of America (IDSA) recognized a significant need for frequently updated systematic reviews of the literature to inform evidence-based best practice guidance. OBJECTIVE The IDSA's goal was to develop an evidence-based diagnostic guideline to assist clinicians, clinical laboratorians, patients and policymakers in decisions related to the optimal use of SARS-CoV-2 nucleic acid amplification tests. In addition, we provide a conceptual framework for understanding molecular diagnostic test performance, discuss the nuance of test result interpretation in a variety of practice settings and highlight important unmet research needs in the COVID-19 diagnostic testing space. METHODS IDSA convened a multidisciplinary panel of infectious diseases clinicians, clinical microbiologists, and experts in systematic literature review to identify and prioritize clinical questions and outcomes related to the use of SARS-CoV-2 molecular diagnostics. Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology was used to assess the certainty of evidence and make testing recommendations. RESULTS The panel agreed on 17 diagnostic recommendations. CONCLUSIONS Universal access to accurate SARS-CoV-2 nucleic acid testing is critical for patient care, hospital infection prevention and the public response to the COVID-19 pandemic. Information on the clinical performance of available tests is rapidly emerging, but the quality of evidence of the current literature is considered moderate to very low. Recognizing these limitations, the IDSA panel weighed available diagnostic evidence and recommends nucleic acid testing for all symptomatic individuals suspected of having COVID-19. In addition, testing is recommended for asymptomatic individuals with known or suspected contact with a COVID-19 case. Testing asymptomatic individuals without known exposure is suggested when the results will impact isolation/quarantine/personal protective equipment (PPE) usage decisions, dictate eligibility for surgery, or inform solid organ or hematopoietic stem cell transplantation timing. Ultimately, prioritization of testing will depend on institutional-specific resources and the needs of different patient populations.
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Affiliation(s)
- Kimberly E Hanson
- Department of Internal Medicine and Pathology, University of Utah, Salt Lake City, Utah
| | - Angela M Caliendo
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Cesar A Arias
- Division of Infectious Diseases, Center for Antimicrobial Resistance and Microbial Genomics, University of Texas Health McGovern Medical School, Center for Infectious Diseases, University of Texas Health School of Public Health, Houston, TX
| | - Mary K Hayden
- Division of Infectious Diseases, Department of Medicine, Rush University Medical Center, Chicago, Illinois; Department of Pathology, Rush University Medical Center, Chicago, Illinois
| | - Janet A Englund
- Department of Pediatrics, University of Washington, Seattle Children’s Research Institute, Seattle, Washington
| | - Mark J Lee
- Department of Pathology and Clinical Microbiology Laboratory, Duke University School of Medicine, Durham, North Carolina
| | - Mark Loeb
- Divinsion of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario
| | - Robin Patel
- Division of Clinical Microbiology, Mayo Clinic, Rochester, Minnesota
| | - Abdallah El Alayli
- Outcomes and Implementation Research Unit, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Osama Altayar
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Payal Patel
- Department of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Medicine, Emory University, Atlanta, Georgia
| | - Yngve Falck-Ytter
- VA Northeast Ohio Healthcare System, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Valery Lavergne
- Department of Pathology and Laboratory Medicine, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Rebecca L Morgan
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario
| | - M Hassan Murad
- Division of Preventive Medicine, Mayo Clinic, Rochester, Minnesota
| | - Shahnaz Sultan
- Division of Gastroenterology, Hepatology, and Nutrition, University of Minnesota, Minneapolis VA Healthcare System, Minneapolis, Minnesota
| | - Adarsh Bhimraj
- Department of Infectious Diseases, Cleveland Clinic, Cleveland, Ohio
| | - Reem A Mustafa
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas
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74
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Lima S, Longman RS. A Diamond in the Rough: IgA-Seq Signatures Stratify New Onset IBD. Cell Host Microbe 2021; 29:10-12. [PMID: 33444552 DOI: 10.1016/j.chom.2020.12.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Intestinal immunoglobulin (Ig)A binds to distinct commensals and pathobionts, but do these IgA-coated bacterial communities define clinical characteristics of inflammatory disease? In this issue of Cell Host & Microbe, Shapiro et al. comprehensively analyze IgA-coated bacteria in new onset inflammatory bowel disease (IBD), revealing their potential in guiding precision therapy and diagnostic stratification.
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Affiliation(s)
- Svetlana Lima
- Division of Gastroenterology and Hepatology, Department of Medicine, Jill Roberts Institute for Research in IBD, Jill Roberts Center for IBD, Weill Cornell Medicine, New York, NY, USA
| | - Randy S Longman
- Division of Gastroenterology and Hepatology, Department of Medicine, Jill Roberts Institute for Research in IBD, Jill Roberts Center for IBD, Weill Cornell Medicine, New York, NY, USA.
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75
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Singh AK, Jena A, Kumar-M P, Jha DK, Sharma V. Clinical presentation of COVID-19 in patients with inflammatory bowel disease: a systematic review and meta-analysis. Intest Res 2021; 20:134-143. [PMID: 33440918 PMCID: PMC8831773 DOI: 10.5217/ir.2020.00108] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 11/18/2020] [Indexed: 12/15/2022] Open
Abstract
Background/Aims Coronavirus disease 2019 (COVID-19) is recognized to have variable clinical manifestations. The clinical presentation of patients with inflammatory bowel disease (IBD) having COVID-19 is unclear. Methods We identified articles reporting about the clinical presentation of COVID-19 in those with underlying IBD from PubMed and Embase. The studies, irrespective of design or language, were included. The overall pooled frequency of various symptoms was estimated. Joanna Briggs Institute Critical appraisal checklist was used to assess the quality of studies. Results Eleven studies, including 1,325 patients, were included in the pooled analysis. The pooled estimates for clinical presentation were; fever: 67.53% (95% confidence interval [CI], 45.38–83.88), cough: 59.58% (95% CI, 45.01–72.63), diarrhea: 27.26% (95% CI, 19.51–36.69), running nose: 27% (95% CI, 15.26–43.19) and dyspnea: 25.29% (95% CI, 18.52–33.52). The pooled prevalence rates for abdominal pain, nausea and vomiting were 13.08% (95% CI, 9.24–18.19), 10.08% (95% CI, 5.84–16.85) and 8.80% (95% CI, 4.43–16.70) per 100 population, respectively. Conclusions The clinical presentation of COVID-19 in IBD patients is similar to the general population.
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Affiliation(s)
- Anupam K Singh
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Anuraag Jena
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Praveen Kumar-M
- Department of Pharmacology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Daya Krishna Jha
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vishal Sharma
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Abstract
The coronavirus disease 2019 (COVID-19) pandemic is an ongoing global health crisis causing major challenges for clinical care in patients with gastrointestinal diseases. Although triggering of anti-viral immune responses is essential for clearance of infection, some patients have severe lung inflammation and multiorgan failure due to marked immune cell dysregulation and cytokine storm syndrome. Importantly, the activation of cytotoxic follicular helper T cells and a reduction of regulatory T cells have a crucial, negative prognostic role. These findings lead to the question of whether immunosuppressive and biologic therapies for gastrointestinal diseases affect the incidence or prognosis of COVID-19 and, thus, whether they should be adjusted to prevent or affect the course of the disease. In this Review, data on the use of such therapies are discussed with a primary focus on inflammatory bowel disease, autoimmune hepatitis and liver transplantation. In particular, the roles of corticosteroids, classic immunosuppressive agents (such as thiopurines and mycophenolate mofetil), small molecules (such as Janus kinase (JAK) inhibitors), and biologic agents (such as tumour necrosis factor (TNF) blockers, vedolizumab and ustekinumab) are reviewed. Finally, the use of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines for the prevention of infection in patients with gastrointestinal diseases and concomitant immunosuppressive or biologic therapy will be discussed.
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Agrawal M, Brenner EJ, Zhang X, Modesto I, Woolcott J, Ungaro RC, Colombel JF, Kappelman MD. Characteristics and Outcomes of IBD Patients with COVID-19 on Tofacitinib Therapy in the SECURE-IBD Registry. Inflamm Bowel Dis 2020; 27:585-589. [PMID: 33325523 PMCID: PMC7799122 DOI: 10.1093/ibd/izaa303] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Indexed: 12/21/2022]
Affiliation(s)
- Manasi Agrawal
- The Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, USA,Address correspondence to: Manasi Agrawal, MD, The Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY 10029, USA. E-mail:
| | - Erica J Brenner
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Xian Zhang
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Irene Modesto
- Inflammation and Immunology, Global Medical Affairs, Pfizer Inc, New York, New York, USA
| | - John Woolcott
- Inflammation and Immunology, Global Medical Affairs, Pfizer Inc, New York, New York, USA
| | - Ryan C Ungaro
- The Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jean-Frederic Colombel
- The Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Michael D Kappelman
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Spalinger MR, Hai R, Li J, Santos AN, Nordgren TM, Tremblay ML, Eckmann L, Hanson E, Scharl M, Wu X, Boland BS, McCole DF. Identification of a Novel Susceptibility Marker for SARS-CoV-2 Infection in Human Subjects and Risk Mitigation with a Clinically Approved JAK Inhibitor in Human/Mouse Cells. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2020:2020.12.09.416586. [PMID: 33330862 PMCID: PMC7743066 DOI: 10.1101/2020.12.09.416586] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Coronavirus disease (COVID-19), caused by SARS-CoV-2, has affected over 65 million individuals and killed over 1.5 million persons (December 8, 2020; www.who.int)1. While fatality rates are higher among the elderly and those with underlying comorbidities2, host factors that promote susceptibility to SARS-CoV-2 infection and severe disease are poorly understood. Although individuals with certain autoimmune/inflammatory disorders show increased susceptibility to viral infections, there is incomplete knowledge of SARS-CoV-2 susceptibility in these diseases.3-7 We report that the autoimmune PTPN2 risk variant rs1893217 promotes expression of the SARS-CoV-2 receptor, ACE2, and increases cellular entry mediated by SARS-CoV-2 spike protein. Elevated ACE2 expression and viral entry were mediated by increased JAK-STAT signalling, and were reversed by the JAK inhibitor, tofacitinib. Collectively, our findings uncover a novel risk biomarker for increased expression of the SARS-CoV-2 receptor and viral entry, and identify a clinically approved therapeutic agent to mitigate this risk.
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Affiliation(s)
- Marianne R. Spalinger
- Division of Biomedical Sciences, School of Medicine, University of California Riverside, Riverside, California, USA
- Department of Gastroenterology and Hepatology, University Hospital Zurich, and University of Zurich, Zurich, Switzerland
| | - Rong Hai
- Department of Microbiology & Plant Pathology, University of California Riverside, Riverside, California, USA
| | - Jiang Li
- Division of Biomedical Sciences, School of Medicine, University of California Riverside, Riverside, California, USA
| | - Alina N. Santos
- Division of Biomedical Sciences, School of Medicine, University of California Riverside, Riverside, California, USA
| | - Tara M. Nordgren
- Division of Biomedical Sciences, School of Medicine, University of California Riverside, Riverside, California, USA
| | - Michel L. Tremblay
- Department of Biochemistry and Goodman Cancer Research Centre, McGill University, Montreal, Quebec, Canada
| | - Lars Eckmann
- Division of Gastroenterology, University of California San Diego, La Jolla, California, USA
| | - Elaine Hanson
- Division of Gastroenterology, University of California San Diego, La Jolla, California, USA
| | - Michael Scharl
- Department of Gastroenterology and Hepatology, University Hospital Zurich, and University of Zurich, Zurich, Switzerland
| | - Xiwei Wu
- Integrative Genomics Core, Beckman Research Institute of City of Hope, Monrovia, California, USA
| | - Brigid S. Boland
- Division of Gastroenterology, University of California San Diego, La Jolla, California, USA
| | - Declan F. McCole
- Division of Biomedical Sciences, School of Medicine, University of California Riverside, Riverside, California, USA
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Fumery M, Matias C, Brochot E. Seroconversion of Immunoglobulins to SARS-CoV2 in Patients With Inflammatory Bowel Disease Patients Treated by Biologics. J Crohns Colitis 2020; 14:1792-1793. [PMID: 32697842 DOI: 10.1093/ecco-jcc/jjaa154] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Mathurin Fumery
- Department of Gastroenterology, Amiens University Hospital, Picardie University, Amiens, France.,PériTox Laboratory, Périnatalité & Risques Toxiques, UMR-I 01 INERIS, Picardie Jules Verne University, Amiens, France
| | - Clement Matias
- Department of Gastroenterology, Amiens University Hospital, Picardie University, Amiens, France
| | - Etienne Brochot
- Department of Virology, EA4294 Amiens University Hospital, Picardie University, Amiens, France
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Nørgård BM, Nielsen J, Knudsen T, Nielsen RG, Larsen MD, Jølving LR, Kjeldsen J. Hospitalization for COVID-19 in patients treated with selected immunosuppressant and immunomodulating agents, compared to the general population: A Danish cohort study. Br J Clin Pharmacol 2020; 87:2111-2120. [PMID: 33098713 DOI: 10.1111/bcp.14622] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 09/22/2020] [Accepted: 10/12/2020] [Indexed: 12/22/2022] Open
Abstract
AIMS In the Danish population, we examined whether patients treated with thiopurines, methotrexate, systemic corticosteroids, anti-tumour necrosis factor (TNF)-α agents, anti-interleukin therapeutic agents, selective immunosuppressive agents and cyclosporine/tacrolimus had an increased risk of hospitalization for COVID- 19, compared to the background population. METHODS A nationwide cohort study including all people alive in Denmark on 1 March 2020. Exposed patients constituted those exposed to thiopurines (n = 5484), methotrexate (n = 17 977), systemic corticosteroids (n = 55 868), anti-TNF-α agents (n = 17 857), anti-interleukin therapeutic agents (n = 3744), selective immunosuppressive agents (n = 3026) and cyclosporine/tacrolimus (n = 1143) in a period of 12 months prior to 1 March 2020 (estimated time of outbreak in Denmark). We estimated the adjusted risk of hospitalization for COVID-19 for patients treated with the above-mentioned categories of medications, compared to the rest of the population. RESULTS The adjusted odds ratios of hospitalization in patients treated with corticosteroids and cyclosporine/tacrolimus were 1.64 (95% confidence interval [CI] 1.35 to 2.00) and 4.75 (95% CI 1.96 to 11.49), respectively. The risks of hospitalization in patients treated with thiopurines, methotrexate, and anti-TNF-α agents, were 1.93 (95% CI 0.91 to 4.08), 0.74 (95% CI 0.43 to 1.28), 1.00 (95% CI 0.52 to 1.94), respectively. The number of outcomes in patients treated with anti-interleukin therapeutic agents and selective immunosuppressive agents was too small for analysis. CONCLUSION Patients treated with systemic corticosteroids and cyclosporine/tacrolimus had a significantly increased risk of being hospitalized for COVID-19. Our study does not uncover whether the increased risk is related to the drug itself, the underlying condition for which the patient is treated or other factors.
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Affiliation(s)
- Bente Mertz Nørgård
- Center for Clinical Epidemiology, Odense University Hospital, Odense, Denmark.,Research Unit of Clinical Epidemiology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Jan Nielsen
- Center for Clinical Epidemiology, Odense University Hospital, Odense, Denmark.,Research Unit of Clinical Epidemiology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Torben Knudsen
- Department of Medicine, Hospital of Southwest Jutland, Esbjerg, Denmark.,Department of Regional Health Science, Center Southwest Jutland, University of Southern Denmark, Esbjerg, Denmark
| | - Rasmus Gaardskaer Nielsen
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark.,Research Unit of Pediatrics, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Michael Due Larsen
- Center for Clinical Epidemiology, Odense University Hospital, Odense, Denmark.,Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Line Riis Jølving
- Center for Clinical Epidemiology, Odense University Hospital, Odense, Denmark.,Research Unit of Clinical Epidemiology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Jens Kjeldsen
- Department of Medical Gastroenterology S, Odense University Hospital, Odense, Denmark.,Research Unit of Medical Gastroenterology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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81
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Toyonaga T, Araba KC, Kennedy MM, Keith BP, Wolber EA, Beasley C, Steinbach EC, Schaner MR, Jain A, Long MD, Barnes EL, Herfarth HH, Isaacs KL, Hansen JJ, Kapadia M, Gaston Guillem J, Koruda MJ, Rahbar R, Sadiq T, Gulati AS, Sethupathy P, Furey TS, Ehre C, Sheikh SZ. Increased Colonic Expression of ACE2 Associates with Poor Prognosis in Crohn's disease. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2020. [PMID: 33269348 DOI: 10.1101/2020.11.24.396382] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Background and Aims The host receptor for SARS-CoV-2, angiotensin-converting enzyme 2 (ACE2), is highly expressed in small intestine. Our aim was to study colonic ACE2 expression in Crohn's disease (CD) and non-inflammatory bowel disease (non-IBD) controls. We hypothesized that the colonic expression levels of ACE2 impacts CD course. Methods We examined the expression of colon ACE2 using RNA-seq and quantitative (q) RT-PCR from 69 adult CD and 14 NIBD control patients. In a subset of this cohort we validated ACE2 protein expression and localization in formalin-fixed, paraffin-embedded matched colon and ileal tissues using immunohistochemistry. The impact of increased ACE2 expression in CD for the risk of surgery was evaluated by a multivariate regression analysis and a Kaplan-Meier estimator. To provide critical support for the generality of our findings, we analyzed previously published RNA-seq data from two large independent cohorts of CD patients. Results Colonic ACE2 expression was significantly higher in a subset of adult CD patients (ACE2-high CD). IHC in a sampling of ACE2-high CD patients confirmed high ACE2 protein expression in the colon and ileum compared to ACE2-low CD and NIBD patients. Notably, we found that ACE2-high CD patients are significantly more likely to undergo surgery within 5 years of diagnosis, with a Cox regression analysis finding that high ACE2 levels is an independent risk factor (OR 2.18; 95%CI, 1.05-4.55; p=0.037). Conclusion Increased intestinal expression of ACE2 is associated with deteriorated clinical outcomes in CD patients. These data point to the need for molecular stratification that may impact CD disease-related outcomes.
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Macaluso FS, Orlando A. COVID-19 in patients with inflammatory bowel disease: A systematic review of clinical data. Dig Liver Dis 2020; 52:1222-1227. [PMID: 32928672 PMCID: PMC7474894 DOI: 10.1016/j.dld.2020.09.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 08/29/2020] [Accepted: 09/02/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Great efforts by the scientific community are rapidly expanding the evidence on the clinical interplay between Covid-19 and inflammatory bowel disease (IBD). AIMS We performed a systematic review of the literature on published Covid-19 cases occurring in patients with IBD. METHODS PubMed Central/Medline and Embase were systemically searched for records up to May 31, 2020. RESULTS 13 cohort studies and 5 single case reports were included in the qualitative synthesis. A cumulative number of approximately 800 patients with IBD and Covid-19 were identified. The case fatality rate ranged from 0% to 20.0%. Overall, immunomodulators and biologics were not associated with higher risk of Covid-19 or with negative outcomes, while the use of systemic corticosteroids was related to worse prognosis in some studies. CONCLUSIONS This systematic review highlighted two main points that may help clinicians dealing with IBD in reassuring their patients: (1) patients with IBD do not seem to be at higher risk of being infected by SARS-COV-2 than the general population; (2) in case of Covid-19, treatment with immunomodulators or biologics is not associated with worse prognosis, while systemic steroids are suspected to be potentially detrimental, even if more data are needed to confirm this point.
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Affiliation(s)
- Fabio Salvatore Macaluso
- Department of Medicine, ''Villa Sofia-Cervello'' Hospital, Viale Strasburgo 233, 90146 Palermo, Italy.
| | - Ambrogio Orlando
- IBD Unit, ‘‘Villa Sofia-Cervello’’ Hospital, Viale Strasburgo 233, 90146 Palermo, Italy
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83
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Reply to comment: Screening for active COVID-19 infection prior to biologic therapy in IBD patients: primum non nŏcēre. Dig Liver Dis 2020; 52:1248-1249. [PMID: 32811778 PMCID: PMC7383131 DOI: 10.1016/j.dld.2020.07.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 07/20/2020] [Indexed: 12/11/2022]
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84
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D'Amico F, Danese S, Peyrin-Biroulet L. Systematic Review on Inflammatory Bowel Disease Patients With Coronavirus Disease 2019: It Is Time to Take Stock. Clin Gastroenterol Hepatol 2020; 18:2689-2700. [PMID: 32777550 PMCID: PMC7831523 DOI: 10.1016/j.cgh.2020.08.003] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 08/01/2020] [Accepted: 08/04/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS Data on the clinical characteristics of patients with inflammatory bowel diseases (IBDs) with coronavirus disease 2019 (COVID-19) are scarce. The aim of our systematic review was to investigate symptoms and diagnostic-therapeutic management of IBD patients with COVID-19. METHODS We searched PubMed, Embase, Web of Science, and MedRxiv up to July 29, 2020, to identify all studies reporting clinical information on adult and pediatric IBD patients with confirmed COVID-19. RESULTS Twenty-three studies met our inclusion criteria, including 243,760 IBD patients. COVID-19 was diagnosed in 1028 patients (509 with Crohn's disease [49.5%], 428 with ulcerative colitis [41.6%], 49 with indeterminate colitis [4.8%], and 42 with missing data [4.1%]), accounting for a cumulative prevalence of 0.4%. Viral infection occurred more frequently in males than in females (56.5% vs 39.7%), and the mean age ranged from 14 to 85 years. The most common symptoms were fever (48.3%), cough (46.5%), and diarrhea (20.5%), and a COVID-19 diagnosis was achieved mainly through polymerase chain reaction analysis of nasopharyngeal swabs (94.4%) and chest computed tomography scans (38.9%). Hydroxychloroquine (23.9%), lopinavir/ritonavir (8.2%), steroids (3.2%), and antibiotics (3.1%) were the most used drugs. Overall, approximately a third of patients were hospitalized (30.6%), and 11.4% of them required admission to the intensive care unit. In total, 29 COVID-19-related deaths were reported (3.8%), and increasing age and the presence of comorbidities were recognized as risk factors for COVID-19 and negative outcomes. CONCLUSIONS Diarrhea occurs more frequently in IBD patients with COVID-19 than in the non-IBD population. Further studies are needed to define the optimal diagnostic-therapeutic approach in IBD patients with COVID-19.
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Affiliation(s)
- Ferdinando D'Amico
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; Department of Gastroenterology, Inserm Nutrition - Genetics and exposure to environmental risks U1256, University Hospital of Nancy, University of Lorraine, Vandoeuvre-lès-Nancy, France
| | - Silvio Danese
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; Inflammatory Bowel Disease Center, Department of Gastroenterology, Humanitas Clinical and Research Center, Istituto di Ricovero e Cura a Carattere Scientifico, Rozzano Milan, Italy
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology, Inserm Nutrition - Genetics and exposure to environmental risks U1256, University Hospital of Nancy, University of Lorraine, Vandoeuvre-lès-Nancy, France.
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85
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Martínez-Taboada VM, López-Hoyos M, Crespo J, Hernández JL. COVID-19 and immune-mediated inflammatory diseases: Why don't our patients get worse? Clin Exp Rheumatol 2020; 19:102683. [PMID: 33127600 PMCID: PMC7588795 DOI: 10.1016/j.autrev.2020.102683] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 05/15/2020] [Indexed: 12/22/2022]
Affiliation(s)
- Víctor M Martínez-Taboada
- Division of Rheumatology, Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain; University of Cantabria, Santander, Spain
| | - Marcos López-Hoyos
- Division of Immunology, Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain.
| | - Javier Crespo
- Division of Gastroenterology, Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain; University of Cantabria, Santander, Spain
| | - José L Hernández
- Department of Internal Medicine, Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain; University of Cantabria, Santander, Spain
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86
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Burke KE, Kochar B, Allegretti JR, Winter RW, Lochhead P, Khalili H, Colizzo FP, Hamilton MJ, Chan WW, Ananthakrishnan AN. Immunosuppressive Therapy and Risk of COVID-19 Infection in Patients With Inflammatory Bowel Diseases. Inflamm Bowel Dis 2020; 27:155-161. [PMID: 33089863 PMCID: PMC7665507 DOI: 10.1093/ibd/izaa278] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Indexed: 12/15/2022]
Abstract
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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Affiliation(s)
- Kristin E Burke
- Crohn’s and Colitis Center, Massachusetts General Hospital, Boston, MA,Harvard Medical School, Boston, MA
| | - Bharati Kochar
- Crohn’s and Colitis Center, Massachusetts General Hospital, Boston, MA,Harvard Medical School, Boston, MA
| | - Jessica R Allegretti
- Harvard Medical School, Boston, MA,Crohn’s and Colitis Center, Brigham and Women’s Hospital, Boston, MA
| | - Rachel W Winter
- Harvard Medical School, Boston, MA,Crohn’s and Colitis Center, Brigham and Women’s Hospital, Boston, MA
| | - Paul Lochhead
- Crohn’s and Colitis Center, Massachusetts General Hospital, Boston, MA,Harvard Medical School, Boston, MA
| | - Hamed Khalili
- Crohn’s and Colitis Center, Massachusetts General Hospital, Boston, MA,Harvard Medical School, Boston, MA
| | - Francis P Colizzo
- Crohn’s and Colitis Center, Massachusetts General Hospital, Boston, MA,Harvard Medical School, Boston, MA
| | - Matthew J Hamilton
- Harvard Medical School, Boston, MA,Crohn’s and Colitis Center, Brigham and Women’s Hospital, Boston, MA
| | - Walter W Chan
- Harvard Medical School, Boston, MA,Crohn’s and Colitis Center, Brigham and Women’s Hospital, Boston, MA
| | - Ashwin N Ananthakrishnan
- Crohn’s and Colitis Center, Massachusetts General Hospital, Boston, MA,Harvard Medical School, Boston, MA,Address correspondence to: Ashwin N. Ananthakrishnan, MD, MPH, MGH, Crohn’s and Colitis Center, 165 Cambridge Street, 9th Floor, Boston, MA 02114, USA. E-mail:
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87
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Hunt RH, East JE, Lanas A, Malfertheiner P, Satsangi J, Scarpignato C, Webb GJ. COVID-19 and Gastrointestinal Disease: Implications for the Gastroenterologist. Dig Dis 2020; 39:119-139. [PMID: 33040064 PMCID: PMC7705947 DOI: 10.1159/000512152] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 10/08/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND COVID-19 was initially considered a respiratory disease but the SARS-CoV-2 virus can lead to serious systemic consequences affecting major organs including the digestive system. SUMMARY This review brings new clinically important information for the gastroenterologist. This includes: the mechanisms of tissue damage seen with the SARS-CoV-2 virus; the consequences of immunosuppression in patients with inflammatory bowel disease (IBD) and chronic liver disease with the additional risks of decompensation in patients with cirrhosis; the impact of COVID-19 on gastrointestinal emergencies, on gastrointestinal endoscopy, diagnosis and treatments. These highlight the need to understand the clinical pharmacology, toxicology and therapeutic implications of drugs commonly used by gastroenterologists and their links with COVID-19. Key Messages: Any part of the digestive system may be affected by the SARS-CoV-2 virus, and those with pre-existing disease are at greatest risk of adverse outcomes. The risk for drug-drug interactions is considerable in patients seriously ill with COVID-19 who often require mechanical ventilation and life support. Some repurposed drugs used against SARS-CoV-2 can cause or aggravate some of the COVID-19-related gastrointestinal symptoms and can also induce liver injury. Ongoing clinical studies will hopefully identify effective drugs with a more favourable risk-benefit ratio than many initially tried treatments.
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Affiliation(s)
- Richard H. Hunt
- Farncombe Family Digestive Health Research Institute, Division of Gastroenterology, McMaster University, Hamilton, Ontario, Canada,*Richard H. Hunt, Farncombe Family Digestive Health Research Institute, Division of Gastroenterology, McMaster University Health Sciences Centre, Hamilton, ON L8S 4L8 (Canada),
| | - James E. East
- Translational Gastroenterology Unit, Experimental Medicine Division, Nuffield Department of Medicine, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - Angel Lanas
- University Hospital Lozano Blesa, IIS Aragón, CIBER Enfermedades Hepáticas y Digestivas (CIBERehd) Digestive Diseases, Universidad de Zaragoza, Zaragoza, Spain
| | - Peter Malfertheiner
- Klinik für Gastroenterologie, Hepatologie und Infektiologie, Otto-von-Guericke-Universität, Magdeburg, Germany,Med. Klinik und Poliklinik II, Klinikum der Universität, Ludwig Maximilian University of Munich, Munich, Germany
| | - Jack Satsangi
- Consultant Physician, Oxford University NHS Trust and Translational Gastroenterology Unit, Experimental Medicine Division, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom,Department of Gastroenterology, University of Edinburgh, Edinburgh, United Kingdom
| | - Carmelo Scarpignato
- Department of Health Sciences, United Campus of Malta, Msida, Malta,Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China
| | - Gwilym J. Webb
- Oxford Liver Unit, Translational Gastroenterology Unit, Oxford University Hospitals, Oxford, United Kingdom
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88
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Nardone OM, Rispo A, Testa A, Imperatore N, Pellegrini L, Guarino AD, Ricciolino S, Patturelli M, De Palma G, Castiglione F. The impact of a dedicated contact centre on the clinical outcome of patients with inflammatory bowel disease during the COVID-19 outbreak. Therap Adv Gastroenterol 2020; 13:1756284820959586. [PMID: 33024453 PMCID: PMC7520917 DOI: 10.1177/1756284820959586] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 08/27/2020] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND With the interruption of elective activity during the coronavirus disease 2019 (COVID-19) pandemic, a reorganisation of health care for patients with inflammatory bowel disease (IBD) was warranted. We aimed to investigate the effectiveness of a dedicated contact centre service (CCS) on the reorganization of a high-volume IBD centre and on the continuity of care during the COVID-19 outbreak. METHODS We compared the CCS services provided to 3680 IBD patients and clinical outcomes before (January-February 2020) and during (March-April 2020) the COVID-19 period. We further included, as comparator, data from March to April of the previous year (2019). RESULTS During the outbreak, the CCS received an increase of 10.2% of contacts, from 881, in January-February 2020, to 971 (p = 0.02). An increase of 6% in CCS activities was also reported in comparison with March-April 2019 (from 914 to 971 in March-April 2020, p = 0.71). Before COVID-19, in both periods most contacts (67% in January-February 2020 and 60% in March-April 2019) required information about clinical activity, while fewer (33% in January-February 2020 and 40% in March-April 2019) requested logistic information. During the pandemic, most contacts (65.1%) asked to speak with a physician, 23.7% asked for information, while 11.1% wanted to cancel/postpone their appointments. Among all the information, 66% concerned COVID-19. In March-April 2020, 259 outpatient visits were booked, but were all replaced by phone consultations. No difference was detected in the number of intravenous biological administrations (307 versus 296, p = 0.64), surgeries (10 versus 9, p = 0.82) and urgent hospitalisations (10 versus 12, p = 0.67) before and during the COVID-19. CONCLUSION The CCS was an effective tool in the reorganization of the IBD centre. Scheduled visits were replaced by phone calls. The main clinical outcomes were maintained in the COVID-19 period. Virtual follow-up using the CCS could be implemented after the pandemic to optimise the resources of the IBD centre.
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Affiliation(s)
| | - Antonio Rispo
- Gastroenterology, Department of Clinical Medicine and Surgery, University Federico II of Naples, Naples, Italy
| | - Anna Testa
- Gastroenterology, Department of Clinical Medicine and Surgery, University Federico II of Naples, Naples, Italy
| | - Nicola Imperatore
- Gastroenterology, Department of Clinical Medicine and Surgery, University Federico II of Naples, Naples, Italy Gastroenterology and Endoscopy Unit, AORN Antonio Cardarelli, Naples, Italy
| | - Lucienne Pellegrini
- Gastroenterology, Department of Clinical Medicine and Surgery, University Federico II of Naples, Naples, Italy
| | - Alessia Dalila Guarino
- Gastroenterology, Department of Clinical Medicine and Surgery, University Federico II of Naples, Naples, Italy
| | - Simona Ricciolino
- Gastroenterology, Department of Clinical Medicine and Surgery, University Federico II of Naples, Naples, Italy
| | - Marta Patturelli
- Gastroenterology, Department of Clinical Medicine and Surgery, University Federico II of Naples, Naples, Italy
| | - Giovanni De Palma
- Surgical Endoscopy, Department of Clinical Medicine and Surgery, University Federico II of Naples, Naples, Italy
| | - Fabiana Castiglione
- Gastroenterology, Department of Clinical Medicine and Surgery, University Federico II of Naples, Naples, Italy
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89
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Verstockt B, Verstockt S, Abdu Rahiman S, Ke BJ, Arnauts K, Cleynen I, Sabino J, Ferrante M, Matteoli G, Vermeire S. Intestinal Receptor of SARS-CoV-2 in Inflamed IBD Tissue Seems Downregulated by HNF4A in Ileum and Upregulated by Interferon Regulating Factors in Colon. J Crohns Colitis 2020; 15:485-498. [PMID: 32915959 PMCID: PMC7543339 DOI: 10.1093/ecco-jcc/jjaa185] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Patients with inflammatory bowel disease [IBD] are considered immunosuppressed, but do not seem more vulnerable for COVID-19. Nevertheless, intestinal inflammation has shown to be an important risk factor for SARS-CoV-2 infection and prognosis. Therefore, we investigated the role of intestinal inflammation on the viral intestinal entry mechanisms, including ACE2, in IBD. METHODS We collected inflamed and uninflamed mucosal biopsies from Crohn's disease [CD] [n = 193] and ulcerative colitis [UC] [n = 158] patients, and from 51 matched non-IBD controls for RNA sequencing, differential gene expression, and co-expression analysis. Organoids from UC patients were subjected to an inflammatory mix and processed for RNA sequencing. Transmural ileal biopsies were processed for single-cell [sc] sequencing. Publicly available colonic sc-RNA sequencing data, and microarrays from tissue pre/post anti-tumour necrosis factor [TNF] therapy, were analysed. RESULTS In inflamed CD ileum, ACE2 was significantly decreased compared with control ileum [p = 4.6E-07], whereas colonic ACE2 was higher in inflamed colon of CD/UC compared with control [p = 8.3E-03; p = 1.9E-03]. Sc-RNA sequencing confirmed this ACE2 dysregulation and exclusive epithelial ACE2 expression. Network analyses highlighted HNF4A as key regulator of ileal ACE2, and pro-inflammatory cytokines and interferon regulating factors regulated colonic ACE2. Inflammatory stimuli upregulated ACE2 in UC organoids [p = 1.7E-02], but not in non-IBD controls [p = 9.1E-01]. Anti-TNF therapy restored colonic ACE2 regulation in responders. CONCLUSIONS Intestinal inflammation alters SARS-CoV-2 coreceptors in the intestine, with opposing dysregulations in ileum and colon. HNF4A, an IBD susceptibility gene, seems an important upstream regulator of ACE2 in ileum, whereas interferon signalling might dominate in colon.
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Affiliation(s)
- Bram Verstockt
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Leuven, Belgium,Department of Chronic Diseases, Metabolism and Ageing [CHROMETA], Translational Research Center for Gastrointestinal Disorders [TARGID], KU Leuven, Leuven, Belgium
| | - Sare Verstockt
- Department of Chronic Diseases, Metabolism and Ageing [CHROMETA], Translational Research Center for Gastrointestinal Disorders [TARGID], KU Leuven, Leuven, Belgium
| | - Saeed Abdu Rahiman
- Department of Chronic Diseases, Metabolism and Ageing [CHROMETA], Translational Research Center for Gastrointestinal Disorders [TARGID], KU Leuven, Leuven, Belgium
| | - Bo-jun Ke
- Department of Chronic Diseases, Metabolism and Ageing [CHROMETA], Translational Research Center for Gastrointestinal Disorders [TARGID], KU Leuven, Leuven, Belgium
| | - Kaline Arnauts
- Department of Chronic Diseases, Metabolism and Ageing [CHROMETA], Translational Research Center for Gastrointestinal Disorders [TARGID], KU Leuven, Leuven, Belgium,Department of Development and Regeneration, Stem Cell Institute Leuven [SCIL], KU Leuven, Leuven, Belgium
| | - Isabelle Cleynen
- Department of Human Genetics, Laboratory for Complex Genetics, KU Leuven, Leuven, Belgium
| | - João Sabino
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Leuven, Belgium,Department of Chronic Diseases, Metabolism and Ageing [CHROMETA], Translational Research Center for Gastrointestinal Disorders [TARGID], KU Leuven, Leuven, Belgium
| | - Marc Ferrante
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Leuven, Belgium,Department of Chronic Diseases, Metabolism and Ageing [CHROMETA], Translational Research Center for Gastrointestinal Disorders [TARGID], KU Leuven, Leuven, Belgium
| | - Gianluca Matteoli
- Department of Chronic Diseases, Metabolism and Ageing [CHROMETA], Translational Research Center for Gastrointestinal Disorders [TARGID], KU Leuven, Leuven, Belgium
| | - Séverine Vermeire
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Leuven, Belgium,Department of Chronic Diseases, Metabolism and Ageing [CHROMETA], Translational Research Center for Gastrointestinal Disorders [TARGID], KU Leuven, Leuven, Belgium,Corresponding author: Séverine Vermeire, MD, PhD, Department of Gastroenterology and Hepatology, University Hospitals Leuven, Herestraat 49 3000 Leuven, Belgium. Tel.: 0032 [0]16 34 42 18;
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90
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COVID-19 and Inflammatory Bowel Diseases: Risk Assessment, Shared Molecular Pathways, and Therapeutic Challenges. Gastroenterol Res Pract 2020; 2020:1918035. [PMID: 32714386 PMCID: PMC7352130 DOI: 10.1155/2020/1918035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 06/29/2020] [Indexed: 12/20/2022] Open
Abstract
Background The novel coronavirus SARS-CoV-2 causing COVID-19 disease is yielding a global outbreak with severe threats to public health. In this paper, we aimed at reviewing the current knowledge about COVID-19 infectious risk status in inflammatory bowel disease (IBD) patients requiring immunosuppressive medication. We also focused on several molecular insights that could explain why IBD patients appear not to have higher risks of infection and worse outcomes in COVID-19 than the general population in an attempt to provide scientific support for safer decisions in IBD patient care. Methods PubMed electronic database was interrogated for relevant articles involving data about common molecular pathways and shared treatment strategies between SARS-CoV-2, SARS-CoV-1, MERS-CoV, and inflammatory bowel diseases. Besides, Neural Covidex, an artificial intelligence tool, was used to answer queries about pathogenic coronaviruses and possible IBD interactions using the COVID-19 Open Research Dataset (CORD-19). Discussions. Few molecular and therapeutic interactions between IBD and pathogenic coronaviruses were explored. First, we showed how the activity of soluble angiotensin-converting enzyme 2, CD209L other receptors, and phosphorylated α subunit of eukaryotic translation initiation factor 2 might exert protective impact in IBD in case of coronavirus infection. Second, IBD medication was discussed in the context of possible beneficial effects on COVID-19 pathogeny, including “cytokine storm” prevention and treatment, immunomodulation, interferon signaling blocking, and viral endocytosis inhibition. Conclusions Using the current understanding of SARS-CoV-2 as well as other pathogenic coronaviruses immunopathology, we showed why IBD patients should not be considered at an increased risk of infection or more severe outcomes. Whether our findings are entirely applicable to the pathogenesis, disease susceptibility, and treatment management of SARS-CoV-2 infection in IBD must be further explored.
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91
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Burgueño JF, Abreu MT. Reply to the Letter to the Editor: The Incidence and Outcomes of COVID-19 in Patients With IBD: A Rapid Review and Meta-Analysis. Inflamm Bowel Dis 2020; 26:e127. [PMID: 32619011 PMCID: PMC7337851 DOI: 10.1093/ibd/izaa172] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Juan F Burgueño
- Division of Gastroenterology, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida
| | - Maria T Abreu
- Division of Gastroenterology, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida,Address correspondence to: Maria T. Abreu, MD, 1011 NW 15th Street (D-149), Gautier Building, Suite 510, Miami, FL 33136 ()
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Clinical and Psychological Impact of COVID-19 Infection in Adult Patients with Eosinophilic Gastrointestinal Disorders during the SARS-CoV-2 Outbreak. J Clin Med 2020. [PMID: 32604895 DOI: 10.3390/jcm9062011.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Eosinophilic gastrointestinal diseases (EGIDs) are chronic gastrointestinal conditions requiring corticosteroid and immunosuppressive therapy for disease control. Patients with EGIDs usually report impaired quality of life. We aimed to report the clinical and psychological impact of COVID-19 infection in EGID patients. In this prospective web-based study we invited all consecutive EGID patients attending the University Hospital of Salerno (Campania) and Padua (Veneto) to fill an ad hoc COVID-19 survey. Moreover, a telemedicine service for direct consultation was organized. Data regarding the occurrence and perception of COVID-19 infection as well as clinical information were recorded. The study population included 102 EGID patients (mean age 36.6 years, 34 females), of whom 89 had eosinophilic esophagitis, nine had gastroenteritis, and four had colitis. No patient was diagnosed with COVID-19 or had recurrence of his/her primary disease. All of them were adherent to therapy and preventive measures adoption. Most patients were worried because of COVID-19 and social preventing measures but did not consider themselves at major risk or susceptible to COVID-19 or other infections due to their chronic condition or therapy. Female gender and low education level were associated to a higher psychological perception of COVID-19 compared to lockdown status or other demographic and clinical factors (p < 0.05). Overall, COVID-19 had a limited clinical impact on patients with EGIDs. The degree of education and sex, but not the fact of living in a lockdown area, influenced the perception of SARS-CoV-2 infection.
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Savarino EV, Iovino P, Santonicola A, Ghisa M, Laserra G, Barberio B, Maniero D, Lorenzon G, Ciacci C, Savarino V, Zingone F. Clinical and Psychological Impact of COVID-19 Infection in Adult Patients with Eosinophilic Gastrointestinal Disorders during the SARS-CoV-2 Outbreak. J Clin Med 2020; 9:jcm9062011. [PMID: 32604895 PMCID: PMC7355569 DOI: 10.3390/jcm9062011] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 06/22/2020] [Accepted: 06/23/2020] [Indexed: 02/07/2023] Open
Abstract
Eosinophilic gastrointestinal diseases (EGIDs) are chronic gastrointestinal conditions requiring corticosteroid and immunosuppressive therapy for disease control. Patients with EGIDs usually report impaired quality of life. We aimed to report the clinical and psychological impact of COVID-19 infection in EGID patients. In this prospective web-based study we invited all consecutive EGID patients attending the University Hospital of Salerno (Campania) and Padua (Veneto) to fill an ad hoc COVID-19 survey. Moreover, a telemedicine service for direct consultation was organized. Data regarding the occurrence and perception of COVID-19 infection as well as clinical information were recorded. The study population included 102 EGID patients (mean age 36.6 years, 34 females), of whom 89 had eosinophilic esophagitis, nine had gastroenteritis, and four had colitis. No patient was diagnosed with COVID-19 or had recurrence of his/her primary disease. All of them were adherent to therapy and preventive measures adoption. Most patients were worried because of COVID-19 and social preventing measures but did not consider themselves at major risk or susceptible to COVID-19 or other infections due to their chronic condition or therapy. Female gender and low education level were associated to a higher psychological perception of COVID-19 compared to lockdown status or other demographic and clinical factors (p < 0.05). Overall, COVID-19 had a limited clinical impact on patients with EGIDs. The degree of education and sex, but not the fact of living in a lockdown area, influenced the perception of SARS-CoV-2 infection.
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Affiliation(s)
- Edoardo Vincenzo Savarino
- Gastroenterology Unit, Department of Surgery, Oncology and Gastroenterology, University of Padua, 35128 Padua, Italy; (M.G.); (G.L.); (B.B.); (D.M.); (G.L.); (F.Z.)
- Correspondence: ; Tel.: +39-049-8217749
| | - Paola Iovino
- Department of Medicine, Surgery, Dentistry, Scuola Medica Salernitana, University of Salerno, University Hospital San Giovanni di Dio e Ruggi d’Aragona, 84131 Salerno, Italy; (P.I.); (A.S.); (C.C.)
| | - Antonella Santonicola
- Department of Medicine, Surgery, Dentistry, Scuola Medica Salernitana, University of Salerno, University Hospital San Giovanni di Dio e Ruggi d’Aragona, 84131 Salerno, Italy; (P.I.); (A.S.); (C.C.)
| | - Matteo Ghisa
- Gastroenterology Unit, Department of Surgery, Oncology and Gastroenterology, University of Padua, 35128 Padua, Italy; (M.G.); (G.L.); (B.B.); (D.M.); (G.L.); (F.Z.)
| | - Giorgio Laserra
- Gastroenterology Unit, Department of Surgery, Oncology and Gastroenterology, University of Padua, 35128 Padua, Italy; (M.G.); (G.L.); (B.B.); (D.M.); (G.L.); (F.Z.)
| | - Brigida Barberio
- Gastroenterology Unit, Department of Surgery, Oncology and Gastroenterology, University of Padua, 35128 Padua, Italy; (M.G.); (G.L.); (B.B.); (D.M.); (G.L.); (F.Z.)
| | - Daria Maniero
- Gastroenterology Unit, Department of Surgery, Oncology and Gastroenterology, University of Padua, 35128 Padua, Italy; (M.G.); (G.L.); (B.B.); (D.M.); (G.L.); (F.Z.)
| | - Greta Lorenzon
- Gastroenterology Unit, Department of Surgery, Oncology and Gastroenterology, University of Padua, 35128 Padua, Italy; (M.G.); (G.L.); (B.B.); (D.M.); (G.L.); (F.Z.)
| | - Carolina Ciacci
- Department of Medicine, Surgery, Dentistry, Scuola Medica Salernitana, University of Salerno, University Hospital San Giovanni di Dio e Ruggi d’Aragona, 84131 Salerno, Italy; (P.I.); (A.S.); (C.C.)
| | - Vincenzo Savarino
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, 16126 Genoa, Italy;
| | - Fabiana Zingone
- Gastroenterology Unit, Department of Surgery, Oncology and Gastroenterology, University of Padua, 35128 Padua, Italy; (M.G.); (G.L.); (B.B.); (D.M.); (G.L.); (F.Z.)
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