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Lee MH, Li HJ, Wasuwanich P, Kim SE, Kim JY, Jeong GH, Park S, Yang JW, Kim MS, Yon DK, Lee SW, Koyanagi A, Jacob L, Kim EY, Cheon JH, Shin JI, Smith L. COVID-19 susceptibility and clinical outcomes in inflammatory bowel disease: An updated systematic review and meta-analysis. Rev Med Virol 2023; 33:e2414. [PMID: 36504172 PMCID: PMC9877653 DOI: 10.1002/rmv.2414] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Revised: 11/08/2022] [Accepted: 11/17/2022] [Indexed: 12/14/2022]
Abstract
The susceptibility, risk factors, and prognosis of COVID-19 in patients with inflammatory bowel disease (IBD) remain unknown. Thus, our study aims to assess the prevalence and clinical outcomes of COVID-19 in IBD. We searched PubMed, EMBASE, and medRxiv from 2019 to 1 June 2022 for cohort and case-control studies comparing the prevalence and clinical outcomes of COVID-19 in patients with IBD and in the general population. We also compared the outcomes of patients receiving and not receiving 5-aminosalicylates (ASA), tumour necrosis factor antagonists, biologics, systemic corticosteroids, or immunomodulators for IBD. Thirty five studies were eligible for our analysis. Pooled odds ratio of COVID-19-related hospitalisation, intensive care unit (ICU) admission, or death in IBD compared to in non-IBD were 0.58 (95% confidence interval (CI) = 0.28-1.18), 1.09 (95% CI = 0.27-4.47), and 0.67 (95% CI = 0.32-1.42), respectively. Inflammatory bowel disease was not associated with increased hospitalisation, ICU admission, or death. Susceptibility to COVID-19 did not increase with any drugs for IBD. Hospitalisation, ICU admission, and death were more likely with 5-ASA and corticosteroid use. COVID-19-related hospitalisation (Odds Ratio (OR): 0.53; 95% CI = 0.38-0.74) and death (OR: 0.13; 95% CI = 0.13-0.70) were less likely with Crohn's disease than ulcerative colitis (UC). In conclusion, IBD does not increase the mortality and morbidity of COVID-19. However, physicians should be aware that additional monitoring is needed in UC patients or in patients taking 5-ASA or systemic corticosteroids.
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Affiliation(s)
- Min Ho Lee
- Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Han Jacob Li
- University of Florida College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Paul Wasuwanich
- University of Florida College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Sung Eun Kim
- Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jong Yeob Kim
- Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Gwang Hun Jeong
- Gyeongsang National University College of Medicine, Jinju, Republic of Korea
| | - Seoyeon Park
- Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jae Won Yang
- Department of Nephrology, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Min Seo Kim
- Department of Digital Health, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Seoul, Republic of Korea
| | - Dong Keon Yon
- Department of Pediatrics, Kyung Hee University College of Medicine, Seoul, Korea.,Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Seoul, Republic of Korea
| | - Seung Won Lee
- Department of Precision Medicine, Sungkyunkwan University School of Medicine, Suwon, Republic of Korea
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, ISCIII, Barcelona, Spain.,ICREA, Barcelona, Spain
| | - Louis Jacob
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, ISCIII, Barcelona, Spain.,Faculty of Medicine, University of Versailles Saint-Quentin-en-Yvelines, Montigny-le-Bretonneux, France.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Eun-Young Kim
- Department of Health, Social and Clinical Pharmacy, Evidence-Based and Clinical Research Laboratory, College of Pharmacy, Chung-Ang University, Seoul, Korea
| | - Jae Hee Cheon
- Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jae Il Shin
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Lee Smith
- The Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge, UK
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Bagheri Lankarani K, Roozitalab M, Gholami Z, Yousefi M, Ghahramani S. Inflammatory Bowel Disease during COVID-19 Pandemic: A Prospective Cohort Study of Incidence Rate and Patients' Concerns. Middle East J Dig Dis 2022; 14:24-33. [PMID: 36619720 PMCID: PMC9489320 DOI: 10.34172/mejdd.2022.252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 12/12/2021] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND: During the coronavirus disease 2019 (COVID-19) pandemic, it is imperative to focus on the concerns of patients with chronic diseases regarding the influence of such conditions and medications prescribed for this purpose on their susceptibility to COVID-19 and its severity. This study aimed to evaluate COVID-19 incidence rate, patients' concerns, sources of information, and medication compliance in a cohort of patients suffering from inflammatory bowel disease (IBD). METHODS: In this prospective cohort study, 214 confirmed cases of IBD were followed up within 8 months up to December 20, 2020. In the confirmed cases of COVID-19, the interviews were repeated 3 months later to assess the post-COVID-19 symptoms and conditions. RESULTS: Among 214 patients with IBD, 113 cases (52.8%) were female, and 169 individuals (79%) were suffering from ulcerative colitis (UC). The mean±SD scores of commitment to standard preventive guidance on COVID-19 were 81.6±19. Moreover, 147 patients (69%) had further stated at least one critical apprehension. The main sources of their information on COVID-19 were physicians (n=89, 41.5%) and websites (n=71, 33.1%). In addition, 10 patients with IBD were diagnosed as confirmed cases of COVID-19, one of them expired due to severe acute respiratory syndrome (SARS). CONCLUSION: The incidence of COVID-19 in the cohort of the patients with IBD in this study was broadly comparable to the general reference population. Tight adherence to physical distancing, and if possible, encouragements of patients with IBD to do remote work along with the provision of virtual care to them cannot be overemphasized. Physicians and websites can also play crucial roles in providing accurate information to patients affected with IBD, especially in terms of reassurances for medication compliance.
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Affiliation(s)
- Kamran Bagheri Lankarani
- Health Policy Research Center, Institute of Health, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Marjan Roozitalab
- Clinical Affairs, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Gholami
- Health Policy Research Center, Institute of Health, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Yousefi
- Department of Medicine, School of Medicine, Semnan University of Medical Sciences, Semnan, Iran
| | - Sulmaz Ghahramani
- Health Policy Research Center, Institute of Health, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran,Corresponding Author: Sulmaz Ghahramani, MD Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Building No 2, Eighth Floor, School of Medicine, Zand Avenue, 71348-45794 Tel: + 98 7132309615 Fax: + 98 7132309615
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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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