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Sahyoun LC, Fetene J, McMillan C, Protiva P, Al Bawardy B, Gaidos JKJ, Proctor D. Impact of COVID-19 Treatment on Real-World Outcomes in Inflammatory Bowel Disease. Dig Dis Sci 2024; 69:1654-1660. [PMID: 38466459 DOI: 10.1007/s10620-024-08355-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 02/12/2024] [Indexed: 03/13/2024]
Abstract
BACKGROUND While there are multiple safe and effective agents for COVID-19 treatment, their impact in inflammatory bowel disease (IBD) remains uncertain. AIMS Our objective was to assess the effects of these therapies on both IBD and COVID outcomes. METHODS A single-center retrospective study of adult patients with IBD who contracted COVID-19 between 12/2020 and 11/2022 was performed. Patients were stratified by COVID-19 treatment (antivirals and/or intravenous antibodies) vs no therapy. The primary outcome was the development of severe COVID-19 infection, defined by need for supplemental oxygen, corticosteroids and/or antibiotics, or hospitalization. Secondary outcomes included rates of withholding advanced IBD therapy (defined as biologic agents or small molecules) and of post-COVID-19 IBD flare. RESULTS Of 127 patients with COVID-19 infection, 70% were on advanced therapies, 35% received COVID-19 treatment, and 15% developed severe COVID-19. Those treated for COVID-19 were more likely to be on corticosteroids [odds ratio (OR) 4.61, 95% confidence interval (CI) 1.72-12.39, p = 0.002] or advanced IBD therapies (OR 2.78, 95% CI 1.04-7.43, p = 0.041). After adjusting for age, race, sex, corticosteroid use, obesity, COVID-19 vaccination status, and severe COVID-19 infection, those treated for COVID-19 were more likely to have IBD therapy held (OR 6.95, 95% CI 1.72-28.15, p = 0.007). There was no significant difference in rates of post-COVID-19 IBD flares or severe COVID-19 infection. There were no COVID-related deaths. CONCLUSIONS Patients with IBD on advanced therapies were frequently treated for acute COVID-19. Although COVID-19 treatment was associated with temporary withholding of IBD therapy, it did not result in increased IBD flares.
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Affiliation(s)
- Laura C Sahyoun
- Section of Digestive Diseases, Yale School of Medicine, 333 Cedar St, New Haven, CT, 06520, USA.
- Division of Gastroenterology and Hepatology, Weill Cornell Medicine, 525 East 68th Street, New York, NY, 10065, USA.
| | - Jonathan Fetene
- Section of Digestive Diseases, Yale School of Medicine, 333 Cedar St, New Haven, CT, 06520, USA
| | - Chandler McMillan
- Section of Digestive Diseases, Yale School of Medicine, 333 Cedar St, New Haven, CT, 06520, USA
| | - Petr Protiva
- Section of Digestive Diseases, Yale School of Medicine, 333 Cedar St, New Haven, CT, 06520, USA
- VA Connecticut Health Care System, 950 Campbell Avenue, West Haven, CT, 06516, USA
| | - Badr Al Bawardy
- Section of Digestive Diseases, Yale School of Medicine, 333 Cedar St, New Haven, CT, 06520, USA
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Jill K J Gaidos
- Section of Digestive Diseases, Yale School of Medicine, 333 Cedar St, New Haven, CT, 06520, USA
| | - Deborah Proctor
- Section of Digestive Diseases, Yale School of Medicine, 333 Cedar St, New Haven, CT, 06520, USA
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2
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Naseem K, Sohail A, Quang Nguyen V, Khan A, Cooper G, Lashner B, Katz J, Cominelli F, Regueiro M, Mansoor E. Predictors of Hospital-related Outcomes of COVID-19 Infection in Patients With Inflammatory Bowel Disease in the Early Pandemic Phase: A Nationwide Inpatient Database Survey. Inflamm Bowel Dis 2023:izad200. [PMID: 37725039 DOI: 10.1093/ibd/izad200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND Patients with inflammatory bowel disease (IBD) are at higher risk for severe COVID-19 infection. However, most studies are single-center, and nationwide data in the United States are lacking. This study aimed to investigate hospital-related outcomes and predictors of these outcomes in patients with IBD and COVID-19 infection. METHODS The National Inpatient Sample and National Readmission database were queried for all the patient hospitalizations with IBD with concurrent COVID-19 in the study group and non-COVID-19 related hospitalizations in the control group. For patients under 18 years, elective and trauma-related hospitalizations were excluded. Primary outcomes included mortality, septic shock, mechanical ventilation, and intensive care utilization. Secondary outcomes included length of stay and total hospitalization costs. RESULTS From this query, 8865 adult patients with IBD and COVID-19 were identified. These patients were relatively older (62.8 vs 57.7 years, P < .01), and the majority were females (52.1% with COVID-19 vs 55.2% without COVID-19). Patients with IBD and COVID-19 had higher mortality (12.24% vs 2.55%; P < .01), increased incidence of septic shock (7.9% vs 4.4%; P < .01), mechanical ventilation (11.5% vs 3.7%; P < .01), and intensive care utilization (12% vs 4.6%; P < .01). These patients also had higher mean length of stay (8.28 days vs 5.47 days; P < .01) and total hospitalization costs ($21 390 vs $16 468; P < .01) than those without COVID-19 infection. CONCLUSIONS Patients with IBD and COVID-19 have worse outcomes, with a higher incidence of severe COVID-19 disease, leading to higher mortality rates, longer lengths of stay, and increased total hospitalization costs. Encouraging preventive health measures and treating promptly with advanced COVID-19 therapies may improve outcomes and decrease the healthcare burden.
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Affiliation(s)
| | - Abdullah Sohail
- The University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | | | - Ahmad Khan
- Case Western Reserve University, Cleveland, OH, USA
| | | | | | - Jeffry Katz
- Case Western Reserve University, Cleveland, OH, USA
| | | | | | - Emad Mansoor
- Case Western Reserve University, Cleveland, OH, USA
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3
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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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4
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Perdalkar S, Basthi Mohan P, Musunuri B, Rajpurohit S, Shetty S, Bhat K, Pai CG. Thiopurine therapy in inflammatory bowel disease in the pandemic era: Safe or unsafe? Int Immunopharmacol 2023; 116:109597. [PMID: 36702073 DOI: 10.1016/j.intimp.2022.109597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 12/03/2022] [Accepted: 12/11/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Inflammatory bowel disease (IBD) is a chronic inflammatory condition of the gastrointestinal tract. Crohn's disease (CD) and Ulcerative colitis (UC) are the two major types affecting millions across the globe. Various immunomodulatory drugs consisting of small molecules (thiopurines, methotrexate and tofacitinib) and biologics are used to treat IBD. Thiopurines (TP) are widely used in the treatment of IBD and it plays an important role both alone and in combination with anti-TNF agents as IBD maintenance therapy. Although the advent of biologics therapy has significantly advanced the management of IBD, TP remains the mainstay of treatment in resource-limited and low economic settings. However, the recently commenced pandemic has raised uncertainty over the safety of the use of immunosuppressant drugs such as TP among healthcare care providers and patients, as there is a scarcity of data on whether IBD patients are at higher risk of COVID-19 infection or more prone to its severe outcomes. AIM This review aims to encapsulate evidence on the risk of COVID-19 infection and its severe prognosis in IBD patients on TP. Additionally, it also evaluates the role of TP in inhibiting the viral protease, a potential drug target, essential for the replication and pathogenesis of the virus. CONCLUSION Emerging evidence suggests that TP therapy is safe during the current pandemic and does not carry an elevated risk when used as monotherapy or in combination with other IBD drugs. In-vitro studies demonstrate that TP is a potential therapeutic for present and future betacoronavirus pandemics.
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Affiliation(s)
- Shailesh Perdalkar
- Department of Gastroenterology and Hepatology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal 576104, India
| | - Pooja Basthi Mohan
- Department of Gastroenterology and Hepatology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal 576104, India
| | - Balaji Musunuri
- Department of Gastroenterology and Hepatology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal 576104, India
| | - Siddheesh Rajpurohit
- Department of Gastroenterology and Hepatology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal 576104, India
| | - Shiran Shetty
- Department of Gastroenterology and Hepatology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal 576104, India
| | - Krishnamurthy Bhat
- Department of Pharmaceutical Quality Assurance, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal 576104, India
| | - Cannanore Ganesh Pai
- Department of Gastroenterology and Hepatology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal 576104, India.
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5
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Ai Q, Yang B. Are inflammatory bowel diseases associated with an increased risk of COVID-19 susceptibility and severity? A two-sample Mendelian randomization study. Front Genet 2023; 14:1095050. [PMID: 37152982 PMCID: PMC10160392 DOI: 10.3389/fgene.2023.1095050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 04/13/2023] [Indexed: 05/09/2023] Open
Abstract
Background: Due to inconsistent findings in observational studies regarding the relationship between inflammatory bowel disease (IBD), encompassing ulcerative colitis (UC) and Crohn's disease (CD), and COVID-19, our objective is to explore a potential causative correlation between IBD and COVID-19 susceptibility and its severity using a two-sample Mendelian randomization (MR) analysis. Methods: Using summary data from genome-wide association studies, IBD, including UC and CD, were used as exposure instruments, while COVID-19 susceptibility, hospitalization, and very severe illness were employed as the outcome. The five analysis methods were adopted to evaluate the causal relationship between two diseases, with the inverse variance weighted (IVW) method being the most important. Also, sensitivity analyses were done to make sure that the main results of the MR analyses were reliable. Results: In the analysis using five methods, all p-values were higher than 0.05. There was no association between IBD and COVID-19 susceptibility, hospitalization, and severity in our MR study. The random-effect model was applied due to the existence of heterogeneity. MR-Egger regression revealed no indication of directional pleiotropy, and sensitivity analysis revealed similar relationships. Conclusion: This MR study found no evidence to support that IBD (which includes UC and CD) increases the risk of COVID-19 susceptibility or severity. Our result needs further confirmation through larger epidemiological studies.
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6
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Impact of COVID-19 Pandemic on Initiation of Immunosuppressive Treatment in Immune-Mediated Inflammatory Diseases in Austria: A Nationwide Retrospective Study. J Clin Med 2022; 11:jcm11185308. [PMID: 36142955 PMCID: PMC9503597 DOI: 10.3390/jcm11185308] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 09/01/2022] [Accepted: 09/03/2022] [Indexed: 01/08/2023] Open
Abstract
Objective: Conventional immunosuppressive and advanced targeted therapies, including biological medications and small molecules, are a mainstay in the treatment of immune-mediated inflammatory diseases (IMID). However, the COVID-19 pandemic caused concerns over these drugs’ safety regarding the risk and severity of SARS-CoV-2 infection. Thus, we aimed to assess the impact of the COVID-19 pandemic on the initiation of these treatments in 2020. Study Design and Setting: We conducted a population-based retrospective analysis of real-world data of the Austrian health insurance funds on the initiation of conventional immunosuppressive and advanced targeted therapies. The primary objective was to compare the initiation of these medications in the year 2020 with the period 2017 to 2019. Initiation rates of medication were calculated by comparing a certain unit of time with an average of the previous ones. Results: 95,573 patients were included. During the first lockdown in Austria in April 2020, there was a significant decrease in the initiations of conventional immunosuppressives and advanced targeted therapies compared to previous years (p < 0.0001). From May 2020 onwards, numbers rapidly re-achieved pre-lockdown levels despite higher SARS-CoV-2 infection rates and subsequent lockdown periods at the end of 2020. Independent from the impact of the COVID-19 pandemic, a continuous increase of starts of advanced targeted therapies and a continuous decrease of conventional immunosuppressants during the observation period were observed. Conclusions: In IMID patients, the COVID-19 pandemic led to a significant decrease of newly started conventional immunosuppressive and advanced targeted therapies only during the first lockdown in Austria.
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7
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Wasserbauer M, Hlava S, Trojanek M, Stovicek J, Milota T, Drabek J, Koptová P, Cupkova A, Pichlerová D, Kucerova B, Coufal S, Keil R. Efficacy and safety of SARS-CoV-2 vaccination in patients with inflammatory bowel disease on immunosuppressive and biological therapy: Prospective observational study. PLoS One 2022; 17:e0273612. [PMID: 36054100 PMCID: PMC9439210 DOI: 10.1371/journal.pone.0273612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 08/13/2022] [Indexed: 01/08/2023] Open
Abstract
Background and aims
SARS-CoV-2 is a worldwide serious health problem and vaccination seems to have a crucial role in managing the COVID-19 pandemic. The aim of this prospective observational study was to monitor the trend of antibodies against SARS-CoV-2 after vaccination with BNT162b2 (COMIRNATY) in patients with inflammatory bowel disease treated by immunosuppressive and/or biological therapy, demonstrate whether any type of this therapy is associated with poorer production of antibodies against COVID-19 and evaluate the safety of vaccination against COVID-19 in these patients.
Methods
Eighty-seven eligible patients from one tertiary gastroenterological center with inflammatory bowel disease (60 with CD, 27 with UC) treated by immunosuppressive and/or biological therapy from the antiTNFα group were indicated to vaccination against SARS-CoV-2. Effectiveness of vaccination was evaluated by the values of antibodies before and 4 weeks after 2nd dose of vaccine. Additional goal was to evaluate adverse events of vaccination.
Results
Before the 2nd dose of vaccine, geometric mean of SARS-CoV-2 IgG antibodies were 40.7 U/ml in the biological therapy group, 34.8 U/ml in the azathioprine group and 44.8 U/ml in the combination therapy group of patients. The geometric means were 676.5.7 U/ml in the biological therapy group, 614.4 U/ml in the azathioprine group and 500.1 U/ml in the combination therapy group of patients four weeks after 2nd dose. Statistically significant differences between these groups were not proved. Several non-severe local and general adverse events were present in our patients with a majority of these events on the day of vaccine administration and the day after, no anaphylactic reactions were present.
Conclusions
Our measurements proved the efficacy and safety of vaccination against SARS-CoV-2 in patients with inflammatory bowel disease treated by immunosuppressive and/or biological therapy. Statistically significant differences between our groups of patients were not proved.
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Affiliation(s)
- Martin Wasserbauer
- Department of Internal Medicine, 2nd Faculty of Medicine Charles University in Prague and Motol University Hospital, Prague, Czech Republic
| | - Stepan Hlava
- Department of Internal Medicine, 2nd Faculty of Medicine Charles University in Prague and Motol University Hospital, Prague, Czech Republic
- * E-mail:
| | - Milan Trojanek
- 1st Department of Infectious Diseases, 2nd Medical Faculty Charles University in Prague and Hospital Na Bulovce, Prague, Czech Republic
| | - Jan Stovicek
- Department of Internal Medicine, 2nd Faculty of Medicine Charles University in Prague and Motol University Hospital, Prague, Czech Republic
| | - Tomas Milota
- Department of Immunology, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Jiri Drabek
- Department of Internal Medicine, 2nd Faculty of Medicine Charles University in Prague and Motol University Hospital, Prague, Czech Republic
| | - Petra Koptová
- Department of Internal Medicine, 2nd Faculty of Medicine Charles University in Prague and Motol University Hospital, Prague, Czech Republic
| | - Andrea Cupkova
- Department of Internal Medicine, 2nd Faculty of Medicine Charles University in Prague and Motol University Hospital, Prague, Czech Republic
| | - Dita Pichlerová
- Department of Internal Medicine, 2nd Faculty of Medicine Charles University in Prague and Motol University Hospital, Prague, Czech Republic
| | - Barbora Kucerova
- Department of Pediatric Surgery, 2nd Faculty of Medicine Charles University in Prague and University Hospital Motol, Prague, Czech Republic
| | - Stepan Coufal
- Laboratory of Cellular and Molecular Immunology, Institute of Microbiology of the Czech Academy of Sciences, Prague, Czech Republic
| | - Radan Keil
- Department of Internal Medicine, 2nd Faculty of Medicine Charles University in Prague and Motol University Hospital, Prague, Czech Republic
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8
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Tao S, Wang X, Yang X, Liu Y, Fu Z, Zhang L, Wang Z, Ni J, Shuai Z, Pan H. COVID-19 and inflammatory bowel disease crosstalk: From emerging association to clinical proposal. J Med Virol 2022; 94:5640-5652. [PMID: 35971954 PMCID: PMC9538900 DOI: 10.1002/jmv.28067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 07/29/2022] [Accepted: 08/10/2022] [Indexed: 01/08/2023]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection can cause coronavirus disease 2019 (COVID-19), an acute respiratory inflammation that has emerged worldwide since December 2019, and it quickly became a global epidemic. Inflammatory bowel disease (IBD) is a group of chronic nonspecific intestinal inflammatory diseases whose etiology has not been elucidated. The two have many overlapping symptoms in clinical presentation, such as abdominal pain, diarrhea, pneumonia, etc. Imbalance of the autoimmune system in IBD patients and long-term use of immunosuppressive drugs may increase the risk of infection; and systemic symptoms caused by COVID-19 may also induce or exacerbate intestinal inflammation. It has been found that the SARS-CoV-2 receptor angiotensin converting enzyme 2, which is highly expressed in the lung and intestine, is an inflammatory protective factor, and is downregulated and upregulated in COVID-19 and IBD, respectively, suggesting that there may be a coregulatory pathway. In addition, the immune activation pattern of COVID-19 and the cytokine storm in the inflammatory response have similar roles in IBD, indicating that the two diseases may influence each other. Therefore, this review aimed to address the following research questions: whether SARS-CoV-2 infection leads to the progression of IBD; whether IBD increases the risk of COVID-19 infection and poor prognosis; possible common mechanisms and genetic cross-linking between the two diseases; new treatment and care strategies for IBD patients, and the feasibility and risk of vaccination in the context of the COVID-19 epidemic.
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Affiliation(s)
- Sha‐Sha Tao
- Department of Epidemiology and Biostatistics, School of Public HealthAnhui Medical UniversityHefeiAnhuiChina
| | - Xin‐Yi Wang
- Department of Radiation Oncology, The First Affiliated Hospital of Anhui Medical University, First Clinical Medical CollegeAnhui Medical UniversityHefeiAnhuiChina
| | - Xiao‐Ke Yang
- Department of Rheumatology and ImmunologyThe First Affiliated Hospital of Anhui Medical UniversityHefeiAnhuiChina
| | - Yu‐Chen Liu
- Department of Otolaryngology, Head, and Neck SurgeryThe First Affiliated Hospital of Anhui Medical UniversityHefeiAnhuiChina
| | - Zi‐Yue Fu
- Department of Clinical Medicine, The Second School of Clinical MedicineAnhui Medical UniversityHefeiAnhuiChina
| | - Li‐Zhi Zhang
- Department of Clinical Medicine, The First School of Clinical MedicineAnhui Medical UniversityHefeiAnhuiChina
| | - Zhi‐Xin Wang
- Department of Rheumatology and ImmunologyThe First Affiliated Hospital of Anhui Medical UniversityHefeiAnhuiChina
| | - Jing Ni
- Department of Epidemiology and Biostatistics, School of Public HealthAnhui Medical UniversityHefeiAnhuiChina
| | - Zong‐Wen Shuai
- Department of Rheumatology and ImmunologyThe First Affiliated Hospital of Anhui Medical UniversityHefeiAnhuiChina
| | - Hai‐Feng Pan
- Department of Epidemiology and Biostatistics, School of Public HealthAnhui Medical UniversityHefeiAnhuiChina
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9
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Esposito S, Caminiti C, Giordano R, Argentiero A, Ramundo G, Principi N. Risks of SARS-CoV-2 Infection and Immune Response to COVID-19 Vaccines in Patients With Inflammatory Bowel Disease: Current Evidence. Front Immunol 2022; 13:933774. [PMID: 35812420 PMCID: PMC9260046 DOI: 10.3389/fimmu.2022.933774] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 05/26/2022] [Indexed: 02/05/2023] Open
Abstract
Inflammatory bowel diseases (IBD), including Crohn's disease, ulcerative colitis, and unclassified inflammatory bowel disease, are a group of chronic, immune mediated conditions that are presumed to occur in genetically susceptible individuals because of a dysregulated intestinal immune response to environmental factors. IBD patients can be considered subjects with an aberrant immune response that makes them at increased risk of infections, particularly those due to opportunistic pathogens. In many cases this risk is significantly increased by the therapy they receive. Aim of this narrative review is to describe the impact of SARS-CoV-2 infection and the immunogenicity of COVID-19 vaccines in patients with IBD. Available data indicate that patients with IBD do not have an increased susceptibility to infection with SARS-CoV-2 and that, if infected, in the majority of the cases they must not modify the therapy in place because this does not negatively affect the COVID-19 course. Only corticosteroids should be reduced or suspended due to the risk of causing severe forms. Furthermore, COVID-19 seems to modify the course of IBD mainly due to the impact on intestinal disease of the psychological factors deriving from the measures implemented to deal with the pandemic. The data relating to the immune response induced by SARS-CoV-2 or by COVID-19 vaccines can be considered much less definitive. It seems certain that the immune response to disease and vaccines is not substantially different from that seen in healthy subjects, with the exception of patients treated with anti-tumor necrosis factor alone or in combination with other immunosuppressants who showed a reduced immune response. How much, however, this problem reduces induced protection is not known. Moreover, the impact of SARS-CoV-2 variants on IBD course and immune response to SARS-CoV-2 infection and COVID-19 vaccines has not been studied and deserves attention. Further studies capable of facing and solving unanswered questions are needed in order to adequately protect IBD patients from the risks associated with SARS-CoV-2 infection.
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Affiliation(s)
- Susanna Esposito
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Caterina Caminiti
- Research and Innovation Unit, University Hospital of Parma, Parma, Italy
| | | | - Alberto Argentiero
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Greta Ramundo
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, Parma, Italy
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10
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Macaluso FS, Giuliano A, Fries, W, Viola A, Abbruzzese A, Cappello M, Giuffrida E, Carrozza L, Privitera AC, Magnano A, Ferracane C, Scalisi G, Minissale MG, Giangreco E, Garufi S, Bertolami C, Cucinotta U, Graziano F, Casà A, Renna S, Teresi G, Rizzuto G, Mannino M, Maida M, Orlando A. Severe Activity of Inflammatory Bowel Disease is a Risk Factor for Severe COVID-19. Inflamm Bowel Dis 2022; 29:217-221. [PMID: 35385102 PMCID: PMC9383704 DOI: 10.1093/ibd/izac064] [Citation(s) in RCA: 10] [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] [Received: 11/26/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Data from the first wave of the coronavirus disease 2019 (COVID-19) pandemic suggested that patients with inflammatory bowel disease (IBD) are not at higher risk of being infected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) than the general population and that a worse prognosis is not associated with immunomodulatory drugs, with the possible exception of systemic steroids. METHODS This retrospective, observational study included consecutive IBD patients from the Sicilian Network for Inflammatory Bowel Disease (SN-IBD) cohort who had a SARS-CoV-2 infection diagnosis (polymerase chain reaction-confirmed presence of the viral genome in a nasopharyngeal swab) during the second COVID-19 pandemic wave (September 2020 to December 2020). Data regarding demographics, IBD features and treatments, and comorbidities were analyzed in correlation with COVID-19 clinical outcomes. RESULTS Data on 122 patients (mean age, 43.9 ± 16.7 years; males, 50.0%; Crohn's disease, 62.3%; ulcerative colitis, 37.7%) were reported. Twelve patients developed COVID-19-related pneumonia (9.8%), 4 (3.3%) required respiratory assistance (nonmechanical ventilation or orotracheal intubation), and 4 died (case fatality rate, 3.3%). In a multivariable analysis, age (odds ratio [OR], 1.034; 95% CI, 1.006-1.147; P = .032) and severe IBD activity (OR, 13.465; 95% CI, 1.104-164.182; P = .042) were independent predictors of COVID-19-related pneumonia, while severe IBD activity (OR, 15.359; 95% CI, 1.320-178.677; P = .030) was the only independent predictor of severe COVID-19, a composite endpoint defined as the need for respiratory assistance or death. A trend towards a protective role of tumor necrosis factor α inhibitors on pneumonia development was reported (P = .076). CONCLUSIONS In this cohort of patients with IBD and SARS-CoV-2 infection, severe IBD activity was the only independent risk factor for severe COVID-19.
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Affiliation(s)
- Fabio Salvatore Macaluso
- Inflammatory Bowel Disease Unit, “Villa Sofia-Cervello” Hospital, Palermo, Italy,Address correspondence to: Fabio Salvatore Macaluso, MD, IBD Unit, “Villa Sofia-Cervello” Hospital, Viale Strasburgo 233, 90146 Palermo, Italy ()
| | - Alessandra Giuliano
- Inflammatory Bowel Disease Unit, “Villa Sofia-Cervello” Hospital, Palermo, Italy
| | - Walter Fries,
- Inflammatory Bowel Disease Unit, Policlinico “G. Martino,”Messina, Italy
| | - Anna Viola
- Inflammatory Bowel Disease Unit, Policlinico “G. Martino,”Messina, Italy
| | - Alfredo Abbruzzese
- Inflammatory Bowel Disease Unit, Policlinico “G. Martino,”Messina, Italy
| | - Maria Cappello
- Gastroenterology and Hepatology Section, Promise, University of Palermo, Palermo, Italy
| | - Enrica Giuffrida
- Gastroenterology and Hepatology Section, Promise, University of Palermo, Palermo, Italy
| | - Lucio Carrozza
- Gastroenterology and Hepatology Section, Promise, University of Palermo, Palermo, Italy
| | | | - Antonio Magnano
- Gastroenterology Unit, Policlinico “Vittorio Emanuele,”Catania, Italy
| | | | | | - Maria Giovanna Minissale
- **Gastroenterology and Endoscopy Unit, “Buccheri La Ferla Fatebenefratelli” Hospital, Palermo, Italy
| | | | - Serena Garufi
- Gastroenterology Unit, “S. Elia- M. Raimondi” Hospital, Caltanissetta, Italy
| | | | - Ugo Cucinotta
- Pediatric Gastroenterology and Cystic Fibrosis Unit, University of Messina, Messina, Italy
| | - Francesco Graziano
- Pediatric Gastroenterology and Cystic Fibrosis Unit, University of Messina, Messina, Italy,Pediatric Unit, “Villa Sofia-Cervello” Hospital, Palermo, Italy
| | - Angelo Casà
- Inflammatory Bowel Disease Unit, “Villa Sofia-Cervello” Hospital, Palermo, Italy
| | - Sara Renna
- Inflammatory Bowel Disease Unit, “Villa Sofia-Cervello” Hospital, Palermo, Italy
| | - Giulia Teresi
- Inflammatory Bowel Disease Unit, “Villa Sofia-Cervello” Hospital, Palermo, Italy
| | - Giulia Rizzuto
- Inflammatory Bowel Disease Unit, “Villa Sofia-Cervello” Hospital, Palermo, Italy
| | - Mariella Mannino
- Inflammatory Bowel Disease Unit, “Villa Sofia-Cervello” Hospital, Palermo, Italy
| | - Marcello Maida
- Gastroenterology Unit, “Papardo Piemonte” Hospital, Messina, Italy
| | - Ambrogio Orlando
- Inflammatory Bowel Disease Unit, “Villa Sofia-Cervello” Hospital, Palermo, Italy
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11
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Deputy M, Sahnan K, Worley G, Patel K, Balinskaite V, Bottle A, Aylin P, Burns EM, Hart A, Faiz O. The use of, and outcomes for, inflammatory bowel disease services during the Covid-19 pandemic: a nationwide observational study. Aliment Pharmacol Ther 2022; 55:836-846. [PMID: 35132663 PMCID: PMC9111430 DOI: 10.1111/apt.16800] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 12/20/2021] [Accepted: 01/17/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Inflammatory bowel disease (IBD) services have been particularly affected by the Covid-19 pandemic. Delays in referral to secondary care and access to investigations and surgery have been exacerbated. AIMS To investigate the use of and outcomes for emergency IBD care during the Covid-19 pandemic. METHODS Nationwide observational study using administrative data for England (2015-2020) comparing cohorts admitted from 1 January 2015, to 31 January 2020 (pre-pandemic) and from 1 February 2020, to 31 January 2021 (pandemic). Autoregressive integrated moving average forecast models were run to estimate the counterfactual IBD admissions and procedures for February 2020 to January 2021. RESULTS Large decreases in attendances to hospital for emergency treatment were observed for both acute ulcerative colitis (UC, 16.4%) and acute Crohn's disease (CD, 8.7%). The prevalence of concomitant Covid-19 during the same episode was low [391/16 494 (2.4%) and 349/15 613 (2.2%), respectively]. No significant difference in 30-day mortality was observed. A shorter median length of stay by 1 day for acute IBD admissions was observed (P < 0.0001). A higher rate of emergency readmission within 28 days for acute UC was observed (14.1% vs 13.4%, P = 0.012). All IBD procedures and investigations showed decreases in volume from February 2020 to January 2021 compared with counterfactual estimates. The largest absolute deficit was in endoscopy (17 544 fewer procedures, 35.2% reduction). CONCLUSION There is likely a significant burden of untreated IBD in the community. Patients with IBD may experience clinical harm or protracted decreases in quality of life if care is not prioritised.
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Affiliation(s)
- Mohammed Deputy
- Surgical Epidemiology, Trials and Outcome CentreSt Mark’s Hospital and Academic InstituteHarrowUK
- Department of Surgery and CancerImperial College LondonLondonUK
| | - Kapil Sahnan
- Surgical Epidemiology, Trials and Outcome CentreSt Mark’s Hospital and Academic InstituteHarrowUK
- Department of Surgery and CancerImperial College LondonLondonUK
| | - Guy Worley
- Surgical Epidemiology, Trials and Outcome CentreSt Mark’s Hospital and Academic InstituteHarrowUK
- Department of Surgery and CancerImperial College LondonLondonUK
| | - Komal Patel
- Surgical Epidemiology, Trials and Outcome CentreSt Mark’s Hospital and Academic InstituteHarrowUK
- Department of Surgery and CancerImperial College LondonLondonUK
| | | | - Alex Bottle
- Dr Foster Unit, School of Public HealthImperial College LondonLondonUK
| | - Paul Aylin
- Dr Foster Unit, School of Public HealthImperial College LondonLondonUK
| | - Elaine M Burns
- Surgical Epidemiology, Trials and Outcome CentreSt Mark’s Hospital and Academic InstituteHarrowUK
- Department of Surgery and CancerImperial College LondonLondonUK
| | - Ailsa Hart
- Department of GastroenterologySt Mark’s Hospital and Academic InstituteHarrowUK
| | - Omar Faiz
- Surgical Epidemiology, Trials and Outcome CentreSt Mark’s Hospital and Academic InstituteHarrowUK
- Department of Surgery and CancerImperial College LondonLondonUK
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12
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Au M, Mitrev N, Leong RW, Kariyawasam V. Dual biologic therapy with ocrelizumab for multiple sclerosis and vedolizumab for Crohn’s disease: A case report and review of literature. World J Clin Cases 2022; 10:2569-2576. [PMID: 35434082 PMCID: PMC8968582 DOI: 10.12998/wjcc.v10.i8.2569] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 11/21/2021] [Accepted: 02/10/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Little is known about the safety and efficacy of using two or more biologics for the treatment of immune-mediated diseases, including Crohn’s disease (CD).
CASE SUMMARY This case report and narrative review demonstrate the potential safety of dual biologic therapy (DBT) in a 45-year-old female with two separate immune-mediated diseases. She had a history of multiple sclerosis for which she was receiving treatment with ocrelizumab, and she had been recently diagnosed with CD after presenting with diarrhoea. The CD diagnosis was confirmed radiologically, endoscopically, histologically, and biochemically. The patient received treatment with vedolizumab, a gut-specific inhibitor of the α4β7 integrin on leukocytes. No adverse reactions were observed for the duration of treatment. The safety of ocrelizumab and vedolizumab for the treatment of different immune-mediated diseases was demonstrated.
CONCLUSION DBT may be a safe and effective option for the treatment of refractory disease or multiple immune-mediated diseases. Newer biologics, which have improved safety profiles and gut specificity, may provide promising avenues for treatment. However, caution must be exercised in the appropriate selection of biologics given their inherent immunosuppressive properties, side effects, and efficacy profiles. Current evidence suggests that biologic therapy is not associated with a worse prognosis in patients with coronavirus disease 2019, but treatment decisions should be made in a multidisciplinary setting. Further research from controlled trials is needed to better understand the safety profile of DBT in CD. The immunopathological mechanisms underlying DBT also remain to be clarified.
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Affiliation(s)
- Michael Au
- Department of Gastroenterology and Hepatology, Blacktown and Mt Druitt Hospitals, Western Sydney Local Health District, Sydney 2148, New South Wales, Australia
- Blacktown Clinical School, Western Sydney University, Blacktown 2148, New South Wales, Australia
| | - Nikola Mitrev
- Department of Gastroenterology and Hepatology, Blacktown Hospital, Western Sydney Local Health District, Blacktown 2148, New South Wales, Australia
| | - Rupert W Leong
- Endoscopy Department and Inflammatory Bowel Disease Service, Concord Hospital, Sydney 2137, New South Wales, Australia
- Concord Clinical School, University of Sydney, Sydney 2137, New South Wales, Australia
| | - Viraj Kariyawasam
- Blacktown Clinical School, Western Sydney University, Blacktown 2148, New South Wales, Australia
- Inflammatory Bowel Disease Service, Blacktown Hospital, Western Sydney Local Health District, Blacktown 2148, New South Wales, Austria
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13
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Rutigliani M, Bozzo M, Barberis A, Greppi M, Anelli E, Castellaro L, Bonsignore A, Azzinnaro A, Pesce S, Filauro M, Rollandi GA, Castagnola P, Candiani S, Marcenaro E. Case Report: A Peculiar Case of Inflammatory Colitis After SARS-CoV-2 Infection. Front Immunol 2022; 13:849140. [PMID: 35222440 PMCID: PMC8863600 DOI: 10.3389/fimmu.2022.849140] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 01/21/2022] [Indexed: 11/16/2022] Open
Abstract
We report a case of inflammatory colitis after SARS-CoV-2 infection in a patient with no additional co-morbidity who died within three weeks of hospitalization. As it is becoming increasingly clear that SARS-CoV-2 infection can cause immunological alterations, we investigated the expression of the inhibitory checkpoint PD-1 and its ligand PD-L1 to explore the potential role of this axis in the break of self-tolerance. The presence of the SARS-CoV-2 virus in colon tissue was demonstrated by qRT-PCR and immunohistochemical localization of the nucleocapsid protein. Expression of lymphocyte markers, PD-1, and PD-L1 in colon tissue was investigated by IHC. SARS-CoV-2-immunoreactive cells were detected both in the ulcerated and non-ulcerated mucosal areas. Compared to healthy tissue, where PD-1 is weakly expressed and PD-L1 is absent, PD-1 and PD-L1 expression appears in the inflamed mucosal tissue, as expected, but was mainly confined to non-ulcerative areas. At the same time, these markers were virtually undetectable in areas of mucosal ulceration. Our data show an alteration of the PD-1/PD-L1 axis and suggest a link between SARS-CoV-2 infection and an aberrant autoinflammatory response due to concomitant breakdown of the PD-1/PD-L1 interaction leading to early death of the patient.
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Affiliation(s)
- Mariangela Rutigliani
- Department of Laboratory and Service - Histological and Anatomical Pathology Unit, Ente Ospedaliero (E.O.) Galliera Hospital, Genova, Italy
| | - Matteo Bozzo
- Department of Experimental Medicine, University of Genoa, Genova, Italy
| | - Andrea Barberis
- Department of Abdominal Surgery - General and Hepatopancreatobiliary Surgery Unit, Ente Ospedaliero (E.O.) Galliera Hospital, Genova, Italy
| | - Marco Greppi
- Department of Experimental Medicine, University of Genoa, Genova, Italy
| | - Emanuela Anelli
- Department of Laboratory and Service - Histological and Anatomical Pathology Unit, Ente Ospedaliero (E.O.) Galliera Hospital, Genova, Italy
| | - Luca Castellaro
- Department of Laboratory and Service - Histological and Anatomical Pathology Unit, Ente Ospedaliero (E.O.) Galliera Hospital, Genova, Italy
| | - Alessandro Bonsignore
- IRCCS Ospedale Policlinico San Martino, Genova, Italy.,Section of Legal and Forensic Medicine, Department of Health Sciences, University of Genoa, Genova, Italy
| | - Antonio Azzinnaro
- Department of Abdominal Surgery - General and Hepatopancreatobiliary Surgery Unit, Ente Ospedaliero (E.O.) Galliera Hospital, Genova, Italy
| | - Silvia Pesce
- Department of Experimental Medicine, University of Genoa, Genova, Italy
| | - Marco Filauro
- Department of Abdominal Surgery - General and Hepatopancreatobiliary Surgery Unit, Ente Ospedaliero (E.O.) Galliera Hospital, Genova, Italy
| | - Gian Andrea Rollandi
- Department of Abdominal Surgery - General and Hepatopancreatobiliary Surgery Unit, Ente Ospedaliero (E.O.) Galliera Hospital, Genova, Italy
| | | | - Simona Candiani
- Department of Earth, Environment and Life Sciences, University of Genoa, Genova, Italy
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14
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Darmadi D, Ruslie RH. Immunological Aspect in Inflammatory Bowel Disease. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.7733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Inflammatory bowel disease (IBD) is a chronic inflammation in the alimentary tract due to improper immune response toward external and internal antigens. The disease consists of 2 entities: ulcerative colitis (UC) and Crohn’s disease (CD). The disease’s prevalence is increasing worldwide due to westernization and industrialization. Europe still holds the highest prevalence of IBD in the world. There are 2 peaks of disease incidence. The first is in the third decade of life and the second is in the fourth decade. Slight male predominance is observed in IBD. Internal and external risk factors play important role in the occurrence of IBD including genetic, smoking, reduced fibre intake, less or absent breastfeeding, sedentary occupation, pollution exposure, and medications. The disease carries heavy economic burden and hampers patient’s quality of life. The immune concept of IBD was hypothesized in 1950s since the symptoms resolved with the administration of steroid. Innate and adaptive immune systems are involved in the pathogenesis of IBD. Antigen presenting cells are found hyperactive, intestinal barrier is disrupted, and autophagy activity is increased. Molecular mimicry occurs between foreign and self antigen. The activity of T helper (Th)1, Th2, and Th17 is amplified while regulatory T cell’s activity is suppressed. Pro-inflammatory cytokine production is elevated but anti-inflammatory cytokines is lowered. Finally, there is increased immunoglobulin G level in intestinal mucosa and imbalance of gut microorganism. All the above immune disturbances lead to chronic inflammation in IBD.
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15
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Zulkifli KK, Tan PO, Mustaffa N, Chuah YY, Muthukaruppan R, Ma ZF, Lee YY. Is Gut Involvement a Cause or Effect of COVID-19? Malays J Med Sci 2021; 28:186-193. [PMID: 35002498 PMCID: PMC8715874 DOI: 10.21315/mjms2021.28.6.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 06/24/2021] [Indexed: 01/08/2023] Open
Abstract
Digestive disorder symptoms in COVID-19 may be similar in form to post-infectious functional gastrointestinal disorder (PI-FGID). To cause clinical effects, SARS-CoV-2 must reach the bowels and gastric hypochlorhydria may facilitate such transit. Asian elderly are predisposed to greater infection rate and severity of COVID-19, and the high prevalence of gastric atrophy and intake of proton-pump inhibitor in this aged group might explain the risk. Persistence shedding of SARS-CoV-2 in stools indicates that faecal transmission should not be disregarded. Gut involvement in COVID-19 is mediated by angiotensin-converting enzyme 2 (ACE2) receptor, which serves as the entry point for SARS-CoV-2 in the small bowel. ACE2 dysregulation has an impact on the homeostasis of gut microbiota and altered inflammatory response. Liver injury is variable in COVID-19 and is likely a result of by-stander effects rather than actual viropathic process. Further research is needed to understand if gut involvement is a cause or effect of SARS-CoV-2.
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Affiliation(s)
| | - Phei Oon Tan
- School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Nazri Mustaffa
- School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Yoen Young Chuah
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Ping Tung Christian Hospital, Ping Tung, Taiwan
| | - Raman Muthukaruppan
- Department of Medicine and Gastroenterology Unit, Hospital Queen Elizabeth, Kota Kinabalu, Sabah, Malaysia
| | - Zheng Feei Ma
- School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Yeong Yeh Lee
- School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
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16
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Macaluso FS, Liguori G, Galli M. Vaccinations in patients with inflammatory bowel disease. Dig Liver Dis 2021; 53:1539-1545. [PMID: 34116972 DOI: 10.1016/j.dld.2021.05.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 05/13/2021] [Accepted: 05/15/2021] [Indexed: 02/07/2023]
Abstract
Treatment of inflammatory bowel disease (IBD) frequently requires administration of immunosuppressive therapies, which increases susceptibility to a number of infectious pathogens. However, many infections can be prevented by correct and appropriate utilization of vaccinations. While several guidelines have been published on vaccination schedules in patients with IBD, vaccination rates remain suboptimal and even lower than those in the general population. This is due to many factors including poor awareness of the importance of vaccines by gastroenterologists and general practitioners as well as potential prejudices of patients regarding the safety and benefits of vaccines. With the aim of increasing awareness about the key role of immunization in the management of patients with IBD, the present review examines the existing literature relating to the main vaccinations and their application in these patients. We also summarize current evidence in order to provide clinicians with an easy source of reference for the principal recommendations for prevention of infectious diseases in patients with IBD. In addition, the recommendations about traveling for IBD patients are briefly explored. Lastly, since it is important for gastroenterologists to be aware of recommendations on vaccination, we recommend implementing educational programs to ensure compliance with current guidelines.
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Affiliation(s)
- Fabio Salvatore Macaluso
- Department of Medicine, ''Villa Sofia-Cervello'' Hospital, Sicilian Network for Inflammatory Bowel Disease (SN-IBD), Palermo, Italy.
| | | | - Massimo Galli
- Department of Biomedical and Clinical Sciences, L Sacco" University of Milan, Via Giovan Battista Grassi 74, Milan 20157, Italy
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17
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Viola A, Muscianisi M, Voti RL, Costantino G, Alibrandi A, Fries W. Predictors of Covid-19 vaccination acceptance in IBD patients: a prospective study. Eur J Gastroenterol Hepatol 2021; 33:e1042-e1045. [PMID: 35048662 PMCID: PMC8734570 DOI: 10.1097/meg.0000000000002320] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Adherence to vaccinations is unsatisfactory in the inflammatory diseases (IBD) population because of concerns regarding adverse events or low perception of infectious risk. The aim of this study was to maximise adherence to anti-Covid-19 vaccination in IBD patients. METHODS In the third trimester of 2020, all IBD patients were informed concerning the need for anti-Covid-19 vaccination and family physicians were advised to proceed with anti-Influenza and anti-pneumococcus vaccinations. Demographic data, disease-related data together with acceptance of vaccinations were recorded. From May 2021, vaccinations of IBD patients were directly arranged at our hospital. We registered performance, procrastination or denial of anti-Covid-19 vaccination, type of vaccine and adverse events. RESULTS Five hundred and twenty-three patients were included (Crohn's: 266, ulcerative colitis: 257; M/F 289/234; mean age 48 ± 17 years); 53 patients were excluded from analysis as they became infected with SARS-CoV-2 during the study period; overall adherence to vaccination was 400/470 (85%), procrastinators 44 (9%) and 27 patients (6%) refused. Compared with influenza (58%) and pneumococcus (65%) vaccinations, acceptance was higher for anti-Covid-19 vaccination (P < 0.0001, both). Mild adverse events occurred in 31% and two (0.5%) needed precautionary but uneventful hospitalization. On multiple stepwise regression analysis, factors positively associated with adherence to vaccination were age (P < 0.039; OR, 1.016, 95% CI: 1.001-1.031) and previous anti-influenza vaccination (P < 0.008; OR, 2.071, 95% CI: 1.210-3.545). CONCLUSIONS Direct counselling and on-site administration were associated with a satisfactory acceptance of anti-Covid-19 vaccination, whereas vaccinations against influenza and pneumococcus remained below expected levels. Increased risk perception may account for the observed differences.
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Affiliation(s)
- Anna Viola
- IBD-Unit, Department of Clinical and Experimental Medicine
| | | | | | | | - Angela Alibrandi
- Department of Economics, Unit of Statistical and Mathematical Sciences, University of Messina, Messina, Italy
| | - Walter Fries
- IBD-Unit, Department of Clinical and Experimental Medicine
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18
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Clinical Outcomes of COVID-19 and Impact on Disease Course in Patients with Inflammatory Bowel Disease. Can J Gastroenterol Hepatol 2021; 2021:7591141. [PMID: 34858891 PMCID: PMC8632463 DOI: 10.1155/2021/7591141] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/31/2021] [Accepted: 11/05/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND AND AIMS The impact of COVID-19 has been of great concern in patients with inflammatory bowel disease (IBD) worldwide, including an increased risk of severe outcomes and/or possible flare of IBD. This study aims to evaluate prevalence, outcomes, the impact of COVID-19 in patients with IBD, and risk factors associated with severe COVID-19 or flare of IBD activity. METHODS A consecutive cohort of IBD patients who were diagnosed with COVID-19 infection and followed up at the McGill University Health Care Centre was obtained between March 1, 2020, and April 30, 2021. Demographics, comorbidities, IBD (type, treatments, pre- and post-COVID-19 clinical activity, biomarkers, and endoscopic activity), and COVID-19-related outcomes (pneumonia, hospitalization, death, and flare of IBD disease) were analyzed. RESULTS A cohort of 3,516 IBD patients was included. 82 patients (2.3%) were diagnosed with COVID-19 infection (median age: 39.0 (IQR 27.8-48.0), 77% with Crohn's disease, 50% were female). The prevalence of COVID-19 infection in IBD patients was significantly lower compared to the general population in Canada and Quebec (3.5% versus 4.3%, p < 0.001). Severe COVID-19 occurred in 6 patients (7.3%); 2 patients (2.4%) died. A flare of IBD post-COVID-19 infection was reported in 8 patients (9.8%) within 3 months. Biologic therapy was held during active COVID-19 infection in 37% of patients. Age ≥55 years (odds ratio (OR): 11.1, 95% CI: 1.8-68.0), systemic corticosteroid use (OR: 4.6, 95% CI: 0.7-30.1), active IBD (OR: 3.8, 95% CI: 0.7-20.8), and comorbidity (OR: 4.9, 95% CI: 0.8-28.6) were factors associated with severe COVID-19. After initial infection, 61% of IBD patients received COVID-19 vaccinations. CONCLUSION The prevalence of COVID-19 infection among patients with IBD was lower than that in the general population in Canada. Severe COVID-19, mortality, and flare of IBD were relatively rare, while a large proportion of patients received COVID-19 vaccination. Older age, comorbidities, active IBD disease, and systemic corticosteroid, but not immunosuppressive or biological therapy, were associated with severe COVID-19 infection.
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19
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Kridin K, Schonmann Y, Solomon A, Onn E, Bitan DT, Weinstein O, Cohen AD. Risk of COVID-19 and its complications in patients with atopic dermatitis undergoing dupilumab treatment-a population-based cohort study. Immunol Res 2021; 70:106-113. [PMID: 34647194 PMCID: PMC8514206 DOI: 10.1007/s12026-021-09234-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 08/30/2021] [Indexed: 12/16/2022]
Abstract
The risk of coronavirus disease (COVID-19) infection and its complications among patients with atopic dermatitis (AD) treated by dupilumab is yet to be determined. We aimed to assess the risk of SARS-CoV-2 infection, COVID-19-associated hospitalization, and mortality among patients with AD treated by dupilumab. A population-based cohort study was conducted to compare AD patients treated by dupilumab (n = 238) with those treated by prolonged systemic corticosteroids (≥ 3 months; n = 1,023), phototherapy (n = 461), and azathioprine or mycophenolate mofetil (MMF; n = 194) regarding the incidence of COVID-19 and its complications. The incidence rate of COVID-19, COVID-19-associated hospitalization, and mortality among patients treated by dupilumab was 70.1 (95% CI, 40.5–116.4), 5.0 (95% CI, 0.3–24.7), and 0.0 per 1,000 person-year, respectively. The use of dupilumab was not associated with an increased risk of SARS-CoV-2 infection [adjusted HR for dupilumab vs. prolonged systemic corticosteroids: 1.13 (95% CI, 0.61–2.09); dupilumab vs. phototherapy: 0.80 (95% CI, 0.42–1.53); dupilumab vs. azathioprine/MMF: 1.10 (95% CI, 0.45–2.65)]. Dupilumab was associated with a comparable risk of COVID-19-associated hospitalization [adjusted HR for dupilumab vs. prolonged systemic corticosteroids: 0.35 (95% CI, 0.05–2.71); dupilumab vs. phototherapy: 0.43 (95% CI, 0.05–3.98); dupilumab vs. azathioprine/MMF: 0.25 (95% CI, 0.02–2.74)]. When applicable, the risk of mortality was not elevated in patients with AD treated by dupilumab [HR for dupilumab vs. prolonged systemic corticosteroids: 0.04 (95% CI, 0.00–225.20)]. To conclude, dupilumab does not impose an increased risk of SARS-CoV-2 infection or COVID-19 complications in patients with AD. Dupilumab should be continued and considered as a safe drug for moderate-to-severe AD during the pandemic.
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Affiliation(s)
- Khalaf Kridin
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany. .,Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel. .,Unit of Dermatology and Skin Research Laboratory, Baruch Padeh Medical Center, Poriya, Israel.
| | | | | | - Erez Onn
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel.,Baruch Padeh Medical Center, Poriya, Tiberias, Israel
| | - Dana Tzur Bitan
- Department of Behavioral Sciences, Ariel University, Ariel, Israel
| | - Orly Weinstein
- Clalit Health Services, Tel-Aviv, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Ben-Gurion Ave, Beer Sheva, Israel
| | - Arnon D Cohen
- Clalit Health Services, Tel-Aviv, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Ben-Gurion Ave, Beer Sheva, Israel
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20
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Kridin K, Schonmann Y, Tzur Bitan D, Damiani G, Peretz A, Weinstein O, Cohen AD. Coronavirus Disease 2019 (COVID-19)-Associated Hospitalization and Mortality in Patients with Psoriasis: A Population-Based Study. Am J Clin Dermatol 2021; 22:709-718. [PMID: 34060006 PMCID: PMC8166379 DOI: 10.1007/s40257-021-00605-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2021] [Indexed: 12/16/2022]
Abstract
Background The impact of immune-related conditions on the outcomes of coronavirus disease 2019 (COVID-19) is poorly understood. Determinants of COVID-19 outcomes among patients with psoriasis are yet to be established. Objective Th objective of this study was to characterize a large cohort of patients with psoriasis with COVID-19 and to identify predictors of COVID-19-associated hospitalization and mortality. Methods A population-based nested case-control study was performed using the computerized database of Clalit Health Services, Israel. Multivariable logistic regression was used to estimate odds ratios (ORs) and 95% confidence (CIs) of predictors for COVID-19-associated hospitalization and mortality. Results The study population included 3151 patients with psoriasis who tested positive for COVID-19. Subclinical COVID-19 infection occurred in 2818 (89.4%) of the patients while 122 (3.9%), 71 (2.3%), 123 (3.9%), and 16 (0.5%) of the patients experienced a mild, moderate, severe, and critical disease, respectively. Overall, 332 (10.5%) patients were hospitalized and 50 (1.6%) patients died because of COVID-19 complications. Intake of methotrexate independently predicted COVID-19-associated hospitalization (adjusted OR 2.30; 95% CI 1.11–4.78; p = 0.025). Use of biologic agents was not associated with COVID-19-associated hospitalization (OR 0.75; 95% CI 0.32–1.73; p = 0.491) or mortality (OR 0.85; 95% CI 0.12–6.21; p = 0.870). Older age, the presence of comorbid cardiovascular diseases, metabolic syndrome, chronic obstructive pulmonary disease, and chronic renal failure independently predicted both COVID-19-associated hospitalization and mortality. Conclusions The use of oral methotrexate was associated with an increased odds of COVID-associated hospitalization, whereas the use of biologic drugs was not associated with worse outcomes of COVID-19 among patients with psoriasis. Supplementary Information The online version contains supplementary material available at 10.1007/s40257-021-00605-8.
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Affiliation(s)
- Khalaf Kridin
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany.
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel.
| | | | - Dana Tzur Bitan
- Department of Behavioral Sciences, Ariel University, Ariel, Israel
| | - Giovanni Damiani
- Clinical Dermatology, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | | | - Orly Weinstein
- Clalit Health Services, Tel-Aviv, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Ben-Gurion Ave, Beer Sheva, Israel
| | - Arnon D Cohen
- Clalit Health Services, Tel-Aviv, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Ben-Gurion Ave, Beer Sheva, Israel
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21
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Nassar M, Nso N, Alfishawy M, Novikov A, Yaghi S, Medina L, Toz B, Lakhdar S, Idrees Z, Kim Y, Gurung DO, Siddiqui RS, Zheng D, Agladze M, Sumbly V, Sandhu J, Castillo FC, Chowdhury N, Kondaveeti R, Bhuiyan S, Perez LG, Ranat R, Gonzalez C, Bhangoo H, Williams J, Osman AE, Kong J, Ariyaratnam J, Mohamed M, Omran I, Lopez M, Nyabera A, Landry I, Iqbal S, Gondal AZ, Hassan S, Daoud A, Baraka B, Trandafirescu T, Rizzo V. Current systematic reviews and meta-analyses of COVID-19. World J Virol 2021; 10:182-208. [PMID: 34367933 PMCID: PMC8316876 DOI: 10.5501/wjv.v10.i4.182] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 04/13/2021] [Accepted: 06/03/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) has left a significant impact on the world's health, economic and political systems; as of November 20, 2020, more than 57 million people have been infected worldwide, with over 1.3 million deaths. While the global spotlight is currently focused on combating this pandemic through means ranging from finding a treatment among existing therapeutic agents to inventing a vaccine that can aid in halting the further loss of life.
AIM To collect all systematic reviews and meta-analyses published related to COVID-19 to better identify available evidence, highlight gaps in knowledge, and elucidate further meta-analyses and umbrella reviews that are yet to be performed.
METHODS We explored studies based on systematic reviews and meta-analyses with the key-terms, including severe acute respiratory syndrome (SARS), SARS virus, coronavirus disease, COVID-19, and SARS coronavirus-2. The included studies were extracted from Embase, Medline, and Cochrane databases. The publication timeframe of included studies ranged between January 01, 2020, to October 30, 2020. Studies that were published in languages other than English were not considered for this systematic review. The finalized full-text articles are freely accessible in the public domain.
RESULTS Searching Embase, Medline, and Cochrane databases resulted in 1906, 669, and 19 results, respectively, that comprised 2594 studies. 515 duplicates were subsequently removed, leaving 2079 studies. The inclusion criteria were systematic reviews or meta-analyses. 860 results were excluded for being a review article, scope review, rapid review, panel review, or guideline that produced a total of 1219 studies. After screening articles were categorized, the included articles were put into main groups of clinical presentation, epidemiology, screening and diagnosis, severity assessment, special populations, and treatment. Subsequently, there was a second subclassification into the following groups: gastrointestinal, cardiovascular, neurological, stroke, thrombosis, anosmia and dysgeusia, ocular manifestations, nephrology, cutaneous manifestations, D-dimer, lymphocyte, anticoagulation, antivirals, convalescent plasma, immunosuppressants, corticosteroids, hydroxychloroquine, renin-angiotensin-aldosterone system, technology, diabetes mellitus, obesity, pregnancy, children, mental health, smoking, cancer, and transplant.
CONCLUSION Among the included articles, it is clear that further research is needed regarding treatment options and vaccines. With more studies, data will be less heterogeneous, and statistical analysis can be better applied to provide more robust clinical evidence. This study was not designed to give recommendations regarding the management of COVID-19.
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Affiliation(s)
- Mahmoud Nassar
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Nso Nso
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Mostafa Alfishawy
- Department of Infectious Diseases, Infectious Diseases Consultants and Academic Researchers of Egypt (IDCARE), Cairo 11221, Outside of the US, Egypt
| | - Anastasia Novikov
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Salim Yaghi
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Luis Medina
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Bahtiyar Toz
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Sofia Lakhdar
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Zarwa Idrees
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Yungmin Kim
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Dawa Ongyal Gurung
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Raheel S Siddiqui
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - David Zheng
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Mariam Agladze
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Vikram Sumbly
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Jasmine Sandhu
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Francisco Cuevas Castillo
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Nadya Chowdhury
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Ravali Kondaveeti
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Sakil Bhuiyan
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Laura Guzman Perez
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Riki Ranat
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Carlos Gonzalez
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Harangad Bhangoo
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - John Williams
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Alaa Eldin Osman
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Joyce Kong
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Jonathan Ariyaratnam
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Mahmoud Mohamed
- Department of Medicine, Division of Nephrology, University of Tennessee Health Science Center, Knoxville City, TN 38103, United States
| | - Ismail Omran
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Mariely Lopez
- Department of Medical, St. George's University, West Indies 38901, Grenada
| | - Akwe Nyabera
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Ian Landry
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Saba Iqbal
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Anoosh Zafar Gondal
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Sameen Hassan
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Ahmed Daoud
- Department of Internal Medicine, Faculty of Medicine, Cairo University, Cairo 11221, Egypt
| | - Bahaaeldin Baraka
- Department of Oncology, Broomfiled Hospital, Mid and South Essex NHS Foundation Trust, ESSEX, Chelmsford 12422, United Kingdom
| | - Theo Trandafirescu
- Department of Critical Care Unit, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Vincent Rizzo
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
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22
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Lubis M. Management of Inflammatory Bowel Disease during Coronavirus Disease 2019 Pandemic. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.6482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Inflammatory bowel disease (IBD) is a chronic inflammation consisted of ulcerative colitis and Crohn’s disease. IBD is a global disease with heavy economic burden. Coronavirus disease-2019 (COVID-19) is a novel disease which spread rapidly and becomes a pandemic. This pandemic situation affects the management of IBD. Severe acute respiratory syndrome coronavirus-2 as the etiology of COVID-19 requires angiotensin-converting enzyme (ACE2) as its receptor. ACE2 is found to be abundant in the gastrointestinal tract, particularly the small intestine and colon. This causes the presence of gastrointestinal symptoms in COVID-19 and interacts with gastrointestinal diseases including IBD. The diagnosis of IBD in patients with COVID-19 is similar with general population with precautions regarding endoscopic procedure. IBD does not increase the risk for contracting COVID-19 nor worsen the outcome of COVID-19. The first step in managing patients with IBD during pandemic is by implicating strict health protocol. There is still a controversy regarding surgery for IBD during pandemic. Medications for IBD are safe during pandemic except systemic corticosteroids. IBD patients without COVID-19 should continue their medications until the goal of disease remission is achieved. If asymptomatic COVID-19 is present, corticosteroid dose should be lowered, tapered, and stopped if available. Anti-tumor necrosis factor (TNF) administration should be postponed for 2 weeks. If COVID-19 manifestations exist, systemic corticosteroid, thiopurine, methotrexate, and anti-TNF should be discontinued. Supporting treatment for COVID-19 can be administered safely. In case of relapsing, the treatment of IBD must be started with the limitation of systemic corticosteroid.
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23
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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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24
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The Burden of Coronavirus Disease 2019 and Its Complications in Patients With Atopic Dermatitis-A Nested Case-Control Study. Dermatitis 2021; 32:S45-S52. [PMID: 34138775 DOI: 10.1097/der.0000000000000772] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The burden of coronavirus disease 2019 (COVID-19) among patients with atopic dermatitis (AD) is poorly understood. OBJECTIVES The aims of the study were to characterize a large cohort of COVID-19-positive adult patients with AD and to identify predictors of COVID-19-associated hospitalization and mortality. METHODS A population-based nested case-control study was performed. Multivariable logistic regression was used to evaluate odds ratios and 95% confidence intervals of predictors for COVID-19-associated hospitalization and mortality. RESULTS Of 78,073 adult patients with AD, 3618 (4.6%) tested positive for COVID-19. Subclinical COVID-19 infection occurred in 3368 (93.1%) of COVID-19-positive patients, whereas 123 (3.4%), 46 (1.3%), 55 (1.5%), and 26 (0.7%) patients developed a mild, moderate, severe, and critical disease, respectively. Altogether, 250 patients (6.0%) were hospitalized, and 40 patients (1.1%) died because of COVID-19 complications. Coronavirus disease 2019-associated hospitalization was independently associated with the intake of extended courses of systemic corticosteroids (adjusted odds ratio, 1.96; 95% confidence interval, 1.23-3.14; P = 0.005). None of AD-related variables independently predicted COVID-19-associated mortality. The presence of comorbid metabolic syndrome, chronic obstructive pulmonary disease, chronic renal failure, and depression projected both COVID-19-associated hospitalization and mortality. CONCLUSIONS Prolonged systemic corticosteroids during the pandemic are associated with increased odds of COVID-19-associated hospitalization and should be avoided in patients with AD.
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25
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Kridin K, Schonmann Y, Damiani G, Peretz A, Onn E, Bitan DT, Cohen AD. Tumor necrosis factor inhibitors are associated with a decreased risk of COVID-19-associated hospitalization in patients with psoriasis-A population-based cohort study. Dermatol Ther 2021; 34:e15003. [PMID: 34033207 PMCID: PMC8209905 DOI: 10.1111/dth.15003] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 05/24/2021] [Indexed: 12/12/2022]
Abstract
The risk of coronavirus disease 2019 (COVID-19) and its complications among patients with psoriasis treated by tumor necrosis factor inhibitors (TNFis) remains to be decisively delineated. We aimed to assess the risk of COVID-19 infection, COVID-19-associated hospitalization, and mortality among Israeli patients with psoriasis treated by TNFi relative to other systemic agents. A population-based cohort study was conducted to compare psoriasis patients treated by TNFi (n = 1943), with those treated by methotrexate (n = 1929), ustekinumab (n = 348), and acitretin (n = 1892) regarding COVID-19 outcomes. Risk of investigated outcomes was assessed using uni- and multi-variate Cox regression analyses. The incidence rate of COVID-19, COVID-19-associated hospitalization, and mortality in the TNFi group was 35.8 (95% CI, 26.1-47.9), 0.8 (95% CI, 0.0-4.2), and 0.0 per 1000 person-years, respectively. Exposure to TNFi was associated with a comparable risk of COVID-19 infection [adjusted hazard ration (HR) for TNFi vs methotrexate: 1.07 (95% CI, 0.67-1.71); TNFi vs ustekinumab: 1.07 (95% CI, 0.48-2.40); TNFi vs acitretin: 0.98 (95% CI, 0.61-1.57)]. TNFi was associated with a decreased risk of COVID-19-associated hospitalization relative to methotrexate (adjusted HR, 0.10; 95% CI, 0.01-0.82) and ustekinumab (adjusted HR, 0.04; 95% CI, 0.00-0.64), but not to acitretin (adjusted HR, 1.00; 95% CI, 0.16-6.16). No significant difference in COVID-19-associated mortality was found between the four different groups. TNFi was associated with a decreased risk of admissions due to COVID-19. Our findings substantiate the continuation of TNFi treatment during the pandemic. TNFi may be positively considered in patients with moderate-to-severe psoriasis warranting systemic treatment during the pandemic.
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Affiliation(s)
- Khalaf Kridin
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany.,Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | | | - Giovanni Damiani
- Clinical Dermatology, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.,Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy.,Department of Pharmaceutical and Pharmacological Sciences, University of Padua, Padua, Italy
| | - Avi Peretz
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel.,Baruch Padeh Medical Center, Tiberias, Israel
| | - Erez Onn
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel.,Baruch Padeh Medical Center, Tiberias, Israel
| | - Dana Tzur Bitan
- Department of Behavioral Sciences, Ariel University, Ariel, Israel
| | - Arnon D Cohen
- Clalit Health Services, Tel-Aviv, Israel.,Sial Research Center, Division of Community Health, Ben Gurion University of the Negev, Beer Sheva, Israel
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26
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Rojas A, Schneider I, Lindner C, Gonzàlez I, Morales MA. Receptor for advanced glycation end-products axis and coronavirus disease 2019 in inflammatory bowel diseases: A dangerous liaison? World J Gastroenterol 2021; 27:2270-2280. [PMID: 34040321 PMCID: PMC8130044 DOI: 10.3748/wjg.v27.i19.2270] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 02/22/2021] [Accepted: 04/14/2021] [Indexed: 02/06/2023] Open
Abstract
Compelling evidence supports the crucial role of the receptor for advanced glycation end-products (RAGE) axis activation in many clinical entities. Since the beginning of the coronavirus disease 2019 pandemic, there is an increasing concern about the risk and handling of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in inflammatory gastrointestinal disorders, such as inflammatory bowel diseases (IBD). However, clinical data raised during pandemic suggests that IBD patients do not have an increased risk of contracting SARS-CoV-2 infection or develop a more severe course of infection. In the present review, we intend to highlight how two potentially important contributors to the inflammatory response to SARS-CoV-2 infection in IBD patients, the RAGE axis activation as well as the cross-talk with the renin-angiotensin system, are dampened by the high expression of soluble forms of both RAGE and the angiotensin-converting enzyme (ACE) 2. The soluble form of RAGE functions as a decoy for its ligands, and soluble ACE2 seems to be an additionally attenuating contributor to RAGE axis activation, particularly by avoiding the transactivation of the RAGE axis that can be produced by the virus-mediated imbalance of the ACE/angiotensin II/angiotensin II receptor type 1 pathway.
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Affiliation(s)
- Armando Rojas
- Biomedical Research Labs, Medicine Faculty, Catholic University of Maule, Talca 3634000, Chile
| | - Iván Schneider
- Biomedical Research Labs, Medicine Faculty, Catholic University of Maule, Talca 3634000, Chile
| | - Cristian Lindner
- Biomedical Research Labs, Medicine Faculty, Catholic University of Maule, Talca 3634000, Chile
| | - Ileana Gonzàlez
- Biomedical Research Labs, Medicine Faculty, Catholic University of Maule, Talca 3634000, Chile
| | - Miguel Angel Morales
- Department of Molecular and Clinical Pharmacology Program, Institute of Biomedical Sciences, University of Chile, Santiago 8320000, Chile
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27
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Kridin K, Schonmann Y, Solomon A, Damiani G, Tzur Bitan D, Onn E, Weinstein O, Cohen AD. Risk of COVID-19 Infection, Hospitalization, and Mortality in Patients with Psoriasis Treated by Interleukin-17 Inhibitors. J DERMATOL TREAT 2021; 33:2014-2020. [PMID: 33759683 DOI: 10.1080/09546634.2021.1905766] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND The risk of the infection and its complications under this drug class remains to be determined. OBJECTIVE To evaluate the risk of COVID-19, COVID-19-associated hospitalization, and mortality among patients with psoriasis treated by IL-17I. METHODS A population-based cohort study was performed to compare psoriasis patients treated by IL-17I (n = 680) with those treated by methotrexate (n = 2,153) and non-systemic/non-immunomodulatory treatments (n = 138,750) regarding the incidence of COVID-19 and its complications. RESULTS The use of IL-17I was not associated with an increased risk of COVID-19 infection [adjusted HR for IL-17I vs. methotrexate: 0.91 (95% CI, 0.48-1.72); IL-17I vs. non-systemic/non-immunomodulatory treatments: 0.92 (95% CI, 0.54-1.59)]. IL-17I was associated with comparable risk of COVID-19-associated hospitalization [adjusted HR for IL-17I vs. methotrexate: 0.42 (95% CI, 0.05-3.39); IL-17I vs. non-systemic/non-immunomodulatory treatments: 0.65 (95% CI, 0.09-4.59)] and COVID-19-associated mortality [adjusted HR for IL-17I vs. methotrexate: 7.57 (95% CI, 0.36-157.36); IL-17I vs. non-systemic/non-immunomodulatory treatments: 7.05 (95% CI, 0.96-51.98)]. In a sensitivity analysis, neither secukinumab nor ixekizumab imposed an elevated risk of any of the outcomes of interests. CONCLUSIONS IL-17I treatment does not confer an increased risk of COVID-19 infection or its complications in patients with psoriasis. Our findings support the continuation of IL-17I treatment during the pandemic.
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Affiliation(s)
- Khalaf Kridin
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany.,Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | | | | | - Giovanni Damiani
- Clinical Dermatology, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.,Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Dana Tzur Bitan
- Department of Behavioral Sciences, Ariel University, Ariel, Israel
| | - Erez Onn
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel.,Baruch Padeh Medical Center, Poriya, Tiberias, Israel
| | - Orly Weinstein
- Clalit Health Services, Tel-Aviv, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Ben-Gurion Ave, Beer Sheva, Israel
| | - Arnon D Cohen
- Clalit Health Services, Tel-Aviv, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Ben-Gurion Ave, Beer Sheva, Israel
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Kridin K, Schonmann Y, Weinstein O, Schmidt E, Ludwig RJ, Cohen AD. The risk of COVID-19 in patients with bullous pemphigoid and pemphigus: A population-based cohort study. J Am Acad Dermatol 2021; 85:79-87. [PMID: 33744354 PMCID: PMC7968167 DOI: 10.1016/j.jaad.2021.02.087] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 02/08/2021] [Accepted: 02/14/2021] [Indexed: 12/19/2022]
Abstract
Background The burden of COVID-19 in patients with bullous pemphigoid (BP) and pemphigus is yet to be evaluated. Objective To assess the risks of COVID-19 and COVID-19-associated hospitalization and mortality in patients with BP and pemphigus and to delineate determinants of severe COVID-19 illness among these patients. Methods A population-based cohort study compared COVID-19 and its complications in patients with BP (n = 1845) and pemphigus (n = 1236) with age-, sex-, and ethnicity-matched control subjects. Results The risks of COVID-19 (hazard rate [HR], 1.12; 95% confidence interval [CI], 0.72-1.73; P = .691) and COVID-19-associated hospitalization (HR, 1.58; 95% CI, 0.84-2.98; P = .160) was comparable between patients with BP and controls. The risk of COVID-19-associated mortality was higher among patients with BP (HR, 2.82; 95% CI, 1.15-6.92; P = .023). The risk of COVID-19 (HR, 0.81; 95% CI, 0.44-1.49; P = .496), COVID-19-associated hospitalization (HR, 1.41; 95% CI, 0.53-3.76; P = .499), and COVID-19-associated mortality (HR, 1.33; 95% CI, 0.15-11.92; P = .789) was similar in patients with pemphigus and their controls. Systemic corticosteroids and immunosuppressants did not predispose COVID-19-positive BP and pemphigus patients to a more severe illness. Limitations Retrospective data collection. Conclusions Patients with BP experience increased COVID-19-associated mortality and should be monitored closely. Maintaining systemic corticosteroids and immunosuppressive adjuvant agents during the pandemic is not associated with worse outcomes.
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Affiliation(s)
- Khalaf Kridin
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany; Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel.
| | | | - Orly Weinstein
- Clalit Health Services, Tel-Aviv, Israel; Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Enno Schmidt
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
| | - Ralf J Ludwig
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
| | - Arnon D Cohen
- Clalit Health Services, Tel-Aviv, Israel; Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
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Segal JP, Kumar A, Raine T, Lamb CA, Brookes MJ. The impact of SARS-CoV-2 variants on IBD management. Lancet Gastroenterol Hepatol 2021; 6:343-344. [PMID: 33711289 PMCID: PMC7943390 DOI: 10.1016/s2468-1253(21)00075-3] [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: 02/20/2021] [Revised: 02/23/2021] [Accepted: 02/24/2021] [Indexed: 01/26/2023]
Affiliation(s)
- Jonathan P Segal
- Department of Gastroenterology and Hepatology, Hillingdon Hospital, Uxbridge UB8 3NN, UK.
| | - Aditi Kumar
- Royal Wolverhampton Trust New Cross Hospital, Wolverhampton, UK
| | - Timothy Raine
- Department of Gastroenterology, Cambridge University Hospitals, Cambridge, UK
| | - Christopher A Lamb
- Translational & Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK; Department of Gastroenterology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Matthew J Brookes
- Faculty of Science and Engineering, University of Wolverhampton, Wolverhampton, UK; Department of Gastroenterology, Royal Wolverhampton NHS Trust, Wolverhampton, UK
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30
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Barh D, Tiwari S, Andrade BS, Weener ME, Góes-Neto A, Azevedo V, Ghosh P, Blum K, Ganguly NK. A novel multi-omics-based highly accurate prediction of symptoms, comorbid conditions, and possible long-term complications of COVID-19. Mol Omics 2021; 17:317-337. [PMID: 33683246 DOI: 10.1039/d0mo00189a] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Comprehensive clinical pictures, comorbid conditions, and long-term complications of COVID-19 are still unknown. Recently, using a multi-omics-based strategy, we predicted potential drugs for COVID-19 with ∼70% accuracy. Herein, using a novel multi-omics-based bioinformatic approach and three ways of analysis, we identified the symptoms, comorbid conditions, and short-, mid-, and possible long-term complications of COVID-19 with >90% precision including 27 parent, 170 child, and 403 specific conditions. Among the specific conditions, 36 viral, 53 short-term, 62 short-mid-long-term, 194 mid-long-term, and 57 congenital conditions are identified. At a threshold "count of occurrence" of 4, we found that 83-100% (average 92.67%) of enriched conditions are associated with COVID-19. Except for dry cough and loss of taste, all the other COVID-19-associated mild and severe symptoms are enriched. CVDs, and pulmonary, metabolic, musculoskeletal, neuropsychiatric, kidney, liver, and immune system disorders are top comorbid conditions. Specific diseases like myocardial infarction, hypertension, COPD, lung injury, diabetes, cirrhosis, mood disorders, dementia, macular degeneration, chronic kidney disease, lupus, arthritis, etc. along with several other NCDs were found to be top candidates. Interestingly, many cancers and congenital disorders associated with COVID-19 severity are also identified. Arthritis, gliomas, diabetes, psychiatric disorders, and CVDs having a bidirectional relationship with COVID-19 are also identified as top conditions. Based on our accuracy (>90%), the long-term presence of SARS-CoV-2 RNA in human, and our "genetic remittance" assumption, we hypothesize that all the identified top-ranked conditions could be potential long-term consequences in COVID-19 survivors, warranting long-term observational studies.
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Affiliation(s)
- Debmalya Barh
- Centre for Genomics and Applied Gene Technology, Institute of Integrative Omics and Applied Biotechnology (IIOAB), Nonakuri, Purba Medinipur, WB, India.
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31
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Kridin K, Schmidt E. Epidemiology of Pemphigus. JID INNOVATIONS 2021; 1:100004. [PMID: 34909708 PMCID: PMC8659392 DOI: 10.1016/j.xjidi.2021.100004] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 01/26/2021] [Accepted: 01/26/2021] [Indexed: 01/01/2023] Open
Abstract
Pemphigus is an epidemiologically heterogeneous group of autoimmune bullous diseases comprising pemphigus vulgaris (PV), pemphigus foliaceus, paraneoplastic pemphigus, IgA pemphigus, and pemphigus herpetiformis. Recently, our knowledge about the frequency of pemphigus, which is highly variable between different populations, has considerably expanded, and the first non-HLA genes associated with PV have been identified. In addition, a variety of comorbidities, including other autoimmune diseases, hematological malignancies, and psoriasis, have been described in this variant. Here, initial data about the impact of COVID-19 on this fragile patient population are discussed and perspectives for future epidemiological studies are outlined.
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Key Words
- ACE, angiotensin-converting enzyme
- AIBD, autoimmune bullous disease
- CAAR, chimeric autoantibody receptor
- CI, confidence interval
- DSG, desmoglein
- EADV, European Academy of Dermatology and Venereology
- EC, extracellular
- EMA, European Medicines Agency
- FS, fogo selvage
- HR, hazard ratio
- ICD, International Classification of Diseases
- PF, pemphigus foliaceus
- PNP, paraneoplastic pemphigus
- PV, pemphigus vulgaris
- SMR, standardized mortality ratio
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Affiliation(s)
- Khalaf Kridin
- Lűbeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
- The Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Enno Schmidt
- Lűbeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
- Department of Dermatology, University of Lübeck, Lübeck, Germany
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32
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Nabil A, Elshemy MM, Uto K, Soliman R, Hassan AA, Shiha G, Ebara M. Coronavirus (SARS-CoV-2) in gastroenterology and its current epidemiological situation: An updated review until January 2021. EXCLI JOURNAL 2021; 20:366-385. [PMID: 33746667 PMCID: PMC7975638 DOI: 10.17179/excli2021-3417] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 02/03/2021] [Indexed: 02/06/2023]
Abstract
Coronaviruses are positive-sense single-strand RNA viruses that infect amphibians, birds, and mammals. Coronavirus Disease 2019 (COVID-19) has become a major health problem caused by one of the coronaviruses called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It has spread fast throughout the globe since its first identification in Wuhan, China, in December 2019. Although COVID-19 is principally defined by its respiratory symptoms, it is now clear that the virus can also affect the digestive system causing gastrointestinal (GI) symptoms like diarrhea, loss of appetite, nausea/vomiting, and abdominal pain as a major complaint. GI symptoms could be the initial signs of preceding respiratory signs, carrying a potential for slowed investigation and raised disease transmission opportunities. Various studies recognized the COVID-19 RNA in stool specimens of infected patients, and its viral receptor angiotensin-converting enzyme-2 (ACE-2) is highly expressed in GI epithelial cells. Many cases were reported negative using nasopharyngeal/oropharyngeal swabs and finally, SARS‐CoV‐2 RNA was detected in their anal/rectal swabs and stool specimens. These suggest that COVID-19 can actively infect and replicate in the GI tract. In this review, we elaborate on the close relationship between SARS-CoV-2 and the digestive system, focusing on the current status in the field of COVID-19 in gastroenterology, liver injury, endoscopy, inflammatory bowel disease, imaging, and the potential underlying mechanisms with illustrating the current epidemiological status regarding this pandemic.
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Affiliation(s)
- Ahmed Nabil
- Research Center for Functional Materials, National Institute for Materials Science (NIMS), 1-1Namiki, Tsukuba, Ibaraki 305-0044, Japan.,Biotechnology and Life Sciences Department, Faculty of Postgraduate Studies for Advanced Sciences (PSAS), Beni-Suef University, Beni-Suef, Egypt.,Egyptian Liver Research Institute and Hospital (ELRIAH), Sherbin, El Mansoura, Egypt
| | | | - Koichiro Uto
- Research Center for Functional Materials, National Institute for Materials Science (NIMS), 1-1Namiki, Tsukuba, Ibaraki 305-0044, Japan
| | - Reham Soliman
- Egyptian Liver Research Institute and Hospital (ELRIAH), Sherbin, El Mansoura, Egypt.,Tropical Medicine Department, Faculty of Medicine, Port Said University, Egypt
| | - Ayman A Hassan
- Egyptian Liver Research Institute and Hospital (ELRIAH), Sherbin, El Mansoura, Egypt
| | - Gamal Shiha
- Egyptian Liver Research Institute and Hospital (ELRIAH), Sherbin, El Mansoura, Egypt.,Hepatology and Gastroenterology Unit, Internal Medicine Department, Faculty of Medicine, Mansoura University, Egypt
| | - Mitsuhiro Ebara
- Research Center for Functional Materials, National Institute for Materials Science (NIMS), 1-1Namiki, Tsukuba, Ibaraki 305-0044, Japan.,Graduate School of Pure and Applied Sciences, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8577, Japan.,Graduate School of Industrial Science and Technology, Tokyo University of Science, 6-3-1 Niijuku, Katsushika-ku, Tokyo 125-8585, Japan
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33
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Ghoshal UC, Sahu S, Biswas SN, Singh P, Chaudhary M, Ghoshal U, Tiwari P, Rai S, Mishra SK. Care of inflammatory bowel disease patients during coronavirus disease-19 pandemic using digital health-care technology. JGH OPEN 2021; 5:535-541. [PMID: 33821221 PMCID: PMC8013680 DOI: 10.1002/jgh3.12498] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 12/21/2020] [Accepted: 01/09/2021] [Indexed: 12/11/2022]
Abstract
Background and Aim Although telemedicine is an option for the care of inflammatory bowel disease (IBD) patients during the Coronavirus Disease (COVID)‐19 pandemic, its feasibility and acceptability data are scant. Data on the frequency of COVID‐19 among patients with IBD, quality of life (QOL), access to health care, psychological stress, and anxiety during the COVID‐19 pandemic are scant. Methods Video/audio consultation for IBD patients was undertaken after a web‐based appointment, and data on acceptability, IBD control, Hospital Anxiety Depression Scale (HADS), and World Health Organization Quality of Life questionnaire (WHOQOL‐Bref) were obtained electronically. IBD patients were assessed for COVID‐19 symptoms or contact history and tested using reverse transcriptase polymerase chain reaction (RT‐PCR) on naso‐ oro‐pharyngeal swabs, and data were compared with 16,317 non‐IBD controls. Results Teleconsultation was feasible and acceptable. IBD patients had COVID‐19 as frequently as non‐IBD controls despite immunosuppressive therapy, possibly due to their awareness and preventive practices. Although the physical, psychological, and social QOL scores during the COVID‐19 pandemic were comparable to the prepandemic period, the environmental scores were worse. Psychological tension and interference with work due to pain were lower during the pandemic, which might be influenced by the control of the disease. Conclusions Teleconsultation is a feasible and acceptable alternative for IBD patients. They had COVID‐19 as frequently as non‐IBD controls despite a high frequency of immunosuppressive treatment, possibly due to their awareness of the disease and preventive practices. The QOL scores (except the environmental domains) and psychological issues were quite comparable or even better during the COVID‐19 pandemic than earlier.
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Affiliation(s)
- Uday C Ghoshal
- Department of Gastroenterology Sanjay Gandhi Postgraduate Institute of Medical Sciences Lucknow India
| | - Shikha Sahu
- Department of Gastroenterology Sanjay Gandhi Postgraduate Institute of Medical Sciences Lucknow India
| | - Sugata N Biswas
- Department of Gastroenterology Sanjay Gandhi Postgraduate Institute of Medical Sciences Lucknow India
| | - Prashant Singh
- Department of Gastroenterology Sanjay Gandhi Postgraduate Institute of Medical Sciences Lucknow India
| | - Moni Chaudhary
- Department of Gastroenterology Sanjay Gandhi Postgraduate Institute of Medical Sciences Lucknow India
| | - Ujjala Ghoshal
- Department of Microbiology Sanjay Gandhi Postgraduate Institute of Medical Sciences Lucknow India
| | - Priyanka Tiwari
- School of Telemedicine and Biomedical Informatics Sanjay Gandhi Postgraduate Institute of Medical Sciences Lucknow India
| | - Sushmita Rai
- Department of Gastroenterology Sanjay Gandhi Postgraduate Institute of Medical Sciences Lucknow India
| | - Saroj K Mishra
- School of Telemedicine and Biomedical Informatics Sanjay Gandhi Postgraduate Institute of Medical Sciences Lucknow India
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34
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Quera R, Pizarro G, Simian D, Ibáñez P, Lubascher J, Kronberg U, Flores L, Figueroa C. Impact of COVID-19 on a cohort of patients with inflammatory bowel disease at a specialised centre in Chile. GASTROENTEROLOGIA Y HEPATOLOGIA 2020; 45 Suppl 1:110-112. [PMID: 33227327 PMCID: PMC7678430 DOI: 10.1016/j.gastrohep.2020.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 11/04/2020] [Accepted: 11/09/2020] [Indexed: 10/28/2022]
Affiliation(s)
- Rodrigo Quera
- Programa Enfermedad Inflamatoria Intestinal, Clínica Las Condes, Santiago, Chile; Departamento de Gastroenterología, Clínica Las Condes, Santiago, Chile.
| | - Gonzalo Pizarro
- Programa Enfermedad Inflamatoria Intestinal, Clínica Las Condes, Santiago, Chile; Departamento de Gastroenterología, Clínica Las Condes, Santiago, Chile
| | - Daniela Simian
- Programa Enfermedad Inflamatoria Intestinal, Clínica Las Condes, Santiago, Chile; Dirección Académica, Clínica Las Condes, Santiago, Chile
| | - Patricio Ibáñez
- Programa Enfermedad Inflamatoria Intestinal, Clínica Las Condes, Santiago, Chile; Departamento de Gastroenterología, Clínica Las Condes, Santiago, Chile
| | - Jaime Lubascher
- Programa Enfermedad Inflamatoria Intestinal, Clínica Las Condes, Santiago, Chile; Departamento de Gastroenterología, Clínica Las Condes, Santiago, Chile
| | - Udo Kronberg
- Programa Enfermedad Inflamatoria Intestinal, Clínica Las Condes, Santiago, Chile; Unidad de Coloproctología, Departamento de Cirugía, Clínica Las Condes, Santiago, Chile
| | - Lilian Flores
- Programa Enfermedad Inflamatoria Intestinal, Clínica Las Condes, Santiago, Chile; Departamento de Gastroenterología, Clínica Las Condes, Santiago, Chile
| | - Carolina Figueroa
- Programa Enfermedad Inflamatoria Intestinal, Clínica Las Condes, Santiago, Chile; Departamento de Gastroenterología, Clínica Las Condes, Santiago, Chile
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