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Lelong M, Josien R, Coste-Burel M, Rimbert M, Bressollette-Bodin C, Nancey S, Bouguen G, Allez M, Serrero M, Caillo L, Rouillon C, Blanc P, Laharie D, Olivier R, Peyrin-Biroulet L, Dib N, De Maissin A, Montuclard C, Trang-Poisson C, Vavasseur F, Gallot G, Berthome M, Braudeau C, Chevreuil J, Bourreille A, Le Berre C. The risk of COVID-19 in IBD patients is increased by urban living and is not influenced by disease activity or intravenous biologics. Front Immunol 2023; 14:1243898. [PMID: 37701431 PMCID: PMC10494533 DOI: 10.3389/fimmu.2023.1243898] [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: 06/21/2023] [Accepted: 08/14/2023] [Indexed: 09/14/2023] Open
Abstract
Background Patients with inflammatory bowel disease (IBD) may have a modified immune response to SARS-CoV-2. The objectives were to evaluate the prevalence of COVID-19 in patients treated with infliximab or vedolizumab, to analyze the factors associated with the infection, the impact of treatments and trough levels. Methods Patients with IBD treated with intravenous biologics in 14 French centers were included between March and June 2020 and followed-up for 6 months. Blood samples were collected for serologies and trough levels. The analysis of factors associated with COVID-19 was conducted in a matched 1:1 case-control sub-study with positive patients. Results In total, 1026 patients were included (74.9% infliximab). Over the follow-up period, 420 patients reported the occurrence of COVID-19 symptoms; 342 had been tested of whom 18 were positive. At the end of follow-up, 38 patients had a positive serology. Considering both nasal tests and serologies together, 46 patients (4.5%) had been infected. The risk of COVID-19 was related neither to the use of treatments (whatever the trough levels) nor to disease activity. Infections were more frequent when using public transport or living in flats in urban areas. Conclusions The prevalence rate of COVID-19 in this IBD population treated with intravenous infliximab or vedolizumab was the same as the one in the French population before the start of the vaccination campaign. The risk was increased by urban living and was not influenced by disease activity or biologics. Sanitary barrier measures remain the best way to protect against SARS-CoV-2 in patients with IBD in biological therapy.
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Affiliation(s)
- Margaux Lelong
- Nantes Université, Centre Hospitalier Universitaire (CHU) Nantes, Institut des Maladies de l’Appareil Digestif (IMAD), Hépato-Gastro-Entérologie et Assistance Nutritionnelle, Institut national de la santé et de la recherche médicale (Inserm) CIC 1413, Nantes, France
| | - Régis Josien
- Nantes Université, Centre Hospitalier Universitaire (CHU) Nantes, Laboratoire d’Immunologie Biologique, Centre d’ImmunoMonitorage Nantes-Atlantique (CIMNA), Nantes, France
- Nantes Université, Institut national de la santé et de la recherche médicale (Inserm), Centre Hospitalier Universitaire (CHU) Nantes, CR2TI UMR 1064, Nantes, France
| | - Marianne Coste-Burel
- Nantes Université, Centre Hospitalier Universitaire (CHU) Nantes, Laboratoire de Virologie, Nantes, France
| | - Marie Rimbert
- Nantes Université, Centre Hospitalier Universitaire (CHU) Nantes, Laboratoire d’Immunologie Biologique, Centre d’ImmunoMonitorage Nantes-Atlantique (CIMNA), Nantes, France
| | - Céline Bressollette-Bodin
- Nantes Université, Institut national de la santé et de la recherche médicale (Inserm), Centre Hospitalier Universitaire (CHU) Nantes, CR2TI UMR 1064, Nantes, France
- Nantes Université, Centre Hospitalier Universitaire (CHU) Nantes, Laboratoire de Virologie, Nantes, France
| | - Stéphane Nancey
- Department of Gastroenterology, Lyon-Sud Hospital, Hospices Civils de Lyon, Université Claude Bernard Lyon 1 and INSERM U1111-CIRI, Lyon, France
| | - Guillaume Bouguen
- Centre Hospitalier Universitaire (CHU) and University of Rennes, INSERM, CIC1414, Institut NUMECAN (Nutrition Metabolism and Cancer), Rennes, France
| | - Matthieu Allez
- Gastroenterology Department, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP), INSERM U1160, Université de Paris, Paris, France
| | - Mélanie Serrero
- Department of Gastroenterology, Centre Hospitalier Universitaire (CHU) Marseille, Marseille, France
| | - Ludovic Caillo
- Department of Gastroenterology, Nimes University Hospital, Nîmes, France
| | - Cléa Rouillon
- Department of Gastroenterology, Caen University Hospital, Caen, France
| | - Pierre Blanc
- Service d’hépatogastroentérologie B, Centre Hospitalier Universitaire (CHU) Montpellier et Université Montpellier, Montpellier, France
| | - David Laharie
- Centre Hospitalier Universitaire (CHU) de Bordeaux, Centre Medico-chirurgical Magellan, Hôpital Haut-Lévêque, Gastroenterology department, Université de Bordeaux, INSERM CIC 1401, Bordeaux, France
| | - Raphaël Olivier
- Gastroenterology Department, University Hospital of Poitiers, Poitiers, France
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology and Inserm NGERE U1256, University Hospital of Nancy, University of Lorraine, Vandoeuvre-lès-Nancy, France
| | - Nina Dib
- Department of HepatoGastroenterology, Angers University Hospital, Angers, France
| | - Astrid De Maissin
- Centre Hospitalier Départemental (CHD) La Roche Sur Yon, Department of Gastroenterology, La-Roche-sur-Yon, France
| | - Céline Montuclard
- Department of Endoscopy and Gastroenterology, Valence Public Hospital, Valence, France
| | - Caroline Trang-Poisson
- Nantes Université, Centre Hospitalier Universitaire (CHU) Nantes, Institut des Maladies de l’Appareil Digestif (IMAD), Hépato-Gastro-Entérologie et Assistance Nutritionnelle, Institut national de la santé et de la recherche médicale (Inserm) CIC 1413, Nantes, France
| | - Fabienne Vavasseur
- Nantes Université, Centre Hospitalier Universitaire (CHU) Nantes, Institut des Maladies de l’Appareil Digestif (IMAD), Hépato-Gastro-Entérologie et Assistance Nutritionnelle, Institut national de la santé et de la recherche médicale (Inserm) CIC 1413, Nantes, France
| | - Géraldine Gallot
- Nantes Université, Centre Hospitalier Universitaire (CHU) Nantes, Centre de ressources biologiques (CRB), Nantes, France
| | - Mathilde Berthome
- Nantes Université, Centre Hospitalier Universitaire (CHU) Nantes, Centre de ressources biologiques (CRB), Nantes, France
| | - Cécile Braudeau
- Nantes Université, Centre Hospitalier Universitaire (CHU) Nantes, Laboratoire d’Immunologie Biologique, Centre d’ImmunoMonitorage Nantes-Atlantique (CIMNA), Nantes, France
- Nantes Université, Institut national de la santé et de la recherche médicale (Inserm), Centre Hospitalier Universitaire (CHU) Nantes, CR2TI UMR 1064, Nantes, France
| | - Justine Chevreuil
- Nantes Université, Centre Hospitalier Universitaire (CHU) Nantes, Laboratoire d’Immunologie Biologique, Centre d’ImmunoMonitorage Nantes-Atlantique (CIMNA), Nantes, France
| | - Arnaud Bourreille
- Nantes Université, Centre Hospitalier Universitaire (CHU) Nantes, Institut des Maladies de l’Appareil Digestif (IMAD), Hépato-Gastro-Entérologie et Assistance Nutritionnelle, Institut national de la santé et de la recherche médicale (Inserm) CIC 1413, Nantes, France
| | - Catherine Le Berre
- Nantes Université, Centre Hospitalier Universitaire (CHU) Nantes, Institut des Maladies de l’Appareil Digestif (IMAD), Hépato-Gastro-Entérologie et Assistance Nutritionnelle, Institut national de la santé et de la recherche médicale (Inserm) CIC 1413, Nantes, France
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2
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Bezzio C, Vernero M, Costa S, Armuzzi A, Fiorino G, Ardizzone S, Roselli J, Carparelli S, Orlando A, Caprioli FA, Castiglione F, Viganò C, Ribaldone DG, Zingone F, Monterubbianesi R, Imperatore N, Festa S, Daperno M, Scucchi L, Ferronato A, Pastorelli L, Alimenti E, Balestrieri P, Ricci C, Cappello M, Felice C, Coppini F, Alvisi P, Di Luna I, Gerardi V, Variola A, Mazzuoli S, Lenti MV, Saibeni S. SARS-CoV-2 infection in patients with inflammatory bowel disease: comparison between the first and second pandemic waves. BMC Gastroenterol 2023; 23:230. [PMID: 37407913 DOI: 10.1186/s12876-023-02841-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 05/30/2023] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND In Italy, the incidence of SARS-CoV-2 infection peaked in April and November 2020, defining two pandemic waves of coronavirus disease 2019 (COVID-19). This study compared the characteristics and outcomes of patients with inflammatory bowel disease (IBD) and SARS-CoV-2 infections between pandemic waves. METHODS Observational longitudinal study of IBD patients with SARS-CoV-2 infection. Patients with established diagnoses of IBD and of SARS-CoV-2 infection were consecutively enrolled in two periods: (i) first wave, from 1 March 2020 to 31 May 2020; and (ii) second wave, from 15 September to 15 December 2020. RESULTS We enrolled 937 IBD patients (219 in the first wave, 718 in the second wave). Patients of the first wave were older (mean ± SD: 46.3 ± 16.2 vs. 44.1 ± 15.4 years, p = 0.06), more likely to have ulcerative colitis (58.0% vs. 44.4%, p < 0.001) and comorbidities (48.9% vs. 38.9%; p < 0.01), and more frequently residing in Northern Italy (73.1% vs. 46.0%, p < 0.001) than patients of the second wave. There were no significant differences between pandemic waves in sex (male: 54.3% vs. 53.3%, p = 0.82) or frequency of active IBD (44.3% vs. 39.0%, p = 0.18). The rates of negative outcomes were significantly higher in the first than second wave: pneumonia (27.8% vs. 11.7%, p < 0.001), hospital admission (27.4% vs. 9.7%, p < 0.001), ventilatory support (11.9% vs. 5.4%, p < 0.003) and death (5.5% vs. 1.8%, p < 0.007). CONCLUSION Between the first and second SARS-CoV-2 pandemic waves, demographic, clinical and geographical features of IBD patients were different as were the symptoms and outcomes of infection. These differences are likely due to the different epidemiological situations and diagnostic possibilities between the two waves.
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Affiliation(s)
- Cristina Bezzio
- Gastroenterology Unit, Rho Hospital, ASST Rhodense, Corso Europa 250, 20017, Rho, MI, Italy.
| | - Marta Vernero
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Stefania Costa
- Department of Medical Sciences, University of Turin, Turin, Italy
- , UO Gastroenterology, ASST Milano Ovest, Legnano (MI), Legnano, Italy
| | - Alessandro Armuzzi
- IBD Unit, IRCCS Humanitas Research Hospital, Rozzano, MI, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, Italy
| | - Gionata Fiorino
- Gastroenterology and Endoscopy Unit, IRCCS Ospedale San Raffaele and University Vita-Salute San Raffaele, Milan, Italy
| | - Sandro Ardizzone
- Gastroenterology Unit, ASST Fatebenefratelli Sacco, Milan, Italy
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Jenny Roselli
- Gastroenterology Department, IBD Referral Center, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Sonia Carparelli
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Casa Sollievo Della Sofferenza, San Giovanni Rotondo, Italy
| | | | - Flavio Andrea Caprioli
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università Degli Studi Di Milano, Milan, Italy
| | - Fabiana Castiglione
- Gastroenterology Unit, Department of Clinical Medicine and Surgery, University Federico II of Naples, Naples, Italy
| | - Chiara Viganò
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Davide G Ribaldone
- Division of Gastroenterology, Department of Medical Sciences, Università Di Torino, Turin, Italy
| | - Fabiana Zingone
- Department of Surgical, Oncological and Gastroenterological Sciences - DISCOG, University Hospital, Padua, Italy
| | - Rita Monterubbianesi
- Gastroenterology and Endoscopy Unit, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy
| | - Nicola Imperatore
- Gastroenterology and Endoscopy Unit, P.O. Santa Maria delle Grazie, Pozzuoli, Naples, Italy
| | | | - Marco Daperno
- Gastroenterology Unit, Mauriziano Hospital, Turin, Italy
| | - Ludovica Scucchi
- Department of Systems Medicine, University Tor Vergata, Rome, Italy
| | - Antonio Ferronato
- UOSD Endoscopia Digestiva, Ospedale Alto Vicentino, AULSS 7 Pedemontana, Santorso, VI, Italy
| | - Luca Pastorelli
- Gastroenterology and Liver Unit, School of Medicine at Ospedale San Paolo, Department of Health Sciences, ASST Santi Paolo E Carlo, University of Milan, Milan, Italy
| | | | - Paola Balestrieri
- Gastroenterology and Endoscopy Unit, Policlinico Campus Bio Medico, Rome, Italy
| | - Chiara Ricci
- Gastroenterology Unit, Clinical and Experimental Sciences Department, Spedali Civili Hospital, University of Brescia, Brescia, Italy
| | - Maria Cappello
- Gastroenterology and Hepatology Section, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
| | - Carla Felice
- Medicine 1 Unit, Ca' Foncello University Hospital, Department of Medicine (DIMED), University of Padova, Padova, Italy
| | - Francesca Coppini
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Patrizia Alvisi
- Pediatric Gastroenterology Unit, Maggiore Hospital, Bologna, Italy
| | - Imma Di Luna
- Gastroenterology Unit, Department of Clinical Medicine and Surgery, University Federico II of Naples, Naples, Italy
| | - Viviana Gerardi
- Medicine, Gastroenterology and Digestive Endoscopy Department, Fondazione Poliambulanza, Brescia, Italy
| | - Angela Variola
- IBD Unit, IRCCS Sacro Cuore Don Calabria, Negrar, VR, Italy
| | - Silvia Mazzuoli
- Gastroenterology and Artificial Nutrition Department, Ospedale Monsignor Raffaele Dimiccoli, Barletta, BT, Italy
| | - Marco Vincenzo Lenti
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Italy; First Department of Internal Medicine, San Matteo Hospital Foundation, Pavia, Italy
| | - Simone Saibeni
- Gastroenterology Unit, Rho Hospital, ASST Rhodense, Corso Europa 250, 20017, Rho, MI, Italy
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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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4
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Viazis N, Drygiannakis I, Karmiris K, Theodoropoulou A, Zampeli E, Tzouvala M, Bamias G, Liatsos C, Theocharis G, Vrakas S, Tsironi E, Mathou N, Mantaka A, Christidou A, Koustenis K, Veretanos C, Papathanasiou E, Zacharopoulou E, Tribonias G, Kitsou V, Kartsoli S, Theodoulou A, Michopoulos S, Thomopoulos K, Koutroubakis IE, Mantzaris GJ. The natural history of COVID-19 in vaccinated inflammatory bowel disease patients. Dig Liver Dis 2023; 55:305-309. [PMID: 36658043 PMCID: PMC9843500 DOI: 10.1016/j.dld.2022.12.012] [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: 09/26/2022] [Revised: 11/07/2022] [Accepted: 12/15/2022] [Indexed: 01/18/2023]
Abstract
AIM Assess the characteristics of break through COVID-19 in Inflammatory Bowel Disease (IBD) patients, despite complete vaccination. METHODS Patients who reported a COVID-19 at least 3 weeks after complete vaccination were asked to answer an on-line anonymous questionnaire which included patient and disease characteristics, vaccination history, and the evolution of COVID-19. RESULTS Among 3240 IBD patients who reported complete vaccination between 1st May 2021 and 30thJune 2022, 402 (12.4%) were infected by SARS Cov-2 [223 male, 216 Crohn's disease (CD), 186 Ulcerative Colitis (UC), mean (SD) age 42.3 (14.9) years, mean (SD) IBD duration 10.1 (9.7) years]. Three hundred and sixty-nine patients (91.8%) were infected once and 33 (8.2%) twice. The mean (SD) time between last vaccination and infection was 4.1 (1.6) months. Overall, 351 (87.3%) patients reported mild constitutional and/or respiratory symptoms, 34 (8.4%) were asymptomatic and only 17 patients (4.2%) required hospitalization. Of hospitalized patients, 2 UC patients died of COVID-19 pneumonia. The remaining hospitalized patients did not need high flow oxygen supply or ICU admission. CONCLUSIONS A minority of completely vaccinated IBD patients developed COVID-19 which evolved with mild symptoms and a favorable outcome. These results reinforce the importance of vaccination especially in vulnerable populations.
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Affiliation(s)
- N Viazis
- Gastroenterology Department, Evangelismos-Polykliniki General Hospital, Athens, Greece.
| | - I Drygiannakis
- Gastroenterology Department, University Hospital of Heraklion, Crete, Greece
| | - K Karmiris
- Gastroenterology Department, Venizeleio General Hospital Heraklion, Crete, Greece
| | - A Theodoropoulou
- Gastroenterology Department, Venizeleio General Hospital Heraklion, Crete, Greece
| | - E Zampeli
- Gastroenterology Department, Alexandra General Hospital, Greece
| | - M Tzouvala
- Gastroenterology Department, General Hospital Nikaia Piraeus Agios Panteleimon-General Hospital Dytikis Attikis Agia Varvara, Greece
| | - G Bamias
- Gastroenterology Unit, 3rd Academic Department of Internal Medicine, National and Kapodistrian University of Athens, Sotiria Hospital, Greece
| | - C Liatsos
- Gastroenterology Department, 401 General Military Hospital of Athens, Greece
| | - G Theocharis
- Gastroenterology Department, University Hospital of Patras, Greece
| | - S Vrakas
- Gastroenterology Department, Tzaneio Hospital, Piraeus, Greece
| | - E Tsironi
- Gastroenterology Department, Metaxa Hospital, Piraeus, Greece
| | - N Mathou
- Gastroenterology Department, "Konstantopoulio-Patision" General District Hospital, Nea Ionia, Athens, Greece
| | - A Mantaka
- Gastroenterology Department, General Hospital of Chania, Crete, Greece
| | - A Christidou
- Gastroenterology Department, Evangelismos-Polykliniki General Hospital, Athens, Greece
| | - K Koustenis
- Gastroenterology Department, Evangelismos-Polykliniki General Hospital, Athens, Greece
| | - Ch Veretanos
- Gastroenterology Department, Evangelismos-Polykliniki General Hospital, Athens, Greece
| | - E Papathanasiou
- Gastroenterology Department, Alexandra General Hospital, Greece
| | - E Zacharopoulou
- Gastroenterology Department, General Hospital Nikaia Piraeus Agios Panteleimon-General Hospital Dytikis Attikis Agia Varvara, Greece
| | - G Tribonias
- Gastroenterology Department, General Hospital Nikaia Piraeus Agios Panteleimon-General Hospital Dytikis Attikis Agia Varvara, Greece
| | - V Kitsou
- Gastroenterology Unit, 3rd Academic Department of Internal Medicine, National and Kapodistrian University of Athens, Sotiria Hospital, Greece
| | - S Kartsoli
- Gastroenterology Department, Tzaneio Hospital, Piraeus, Greece
| | - A Theodoulou
- Gastroenterology Department, Metaxa Hospital, Piraeus, Greece
| | - S Michopoulos
- Gastroenterology Department, Alexandra General Hospital, Greece
| | - K Thomopoulos
- Gastroenterology Department, University Hospital of Patras, Greece
| | - I E Koutroubakis
- Gastroenterology Department, University Hospital of Heraklion, Crete, Greece
| | - G J Mantzaris
- Gastroenterology Department, Evangelismos-Polykliniki General Hospital, Athens, Greece
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De Nicolò A, Cusato J, Bezzio C, Saibeni S, Vernero M, Disabato M, Caviglia GP, Ianniello A, Manca A, D’Avolio A, Ribaldone DG. Possible Impact of Vitamin D Status and Supplementation on SARS-CoV-2 Infection Risk and COVID-19 Symptoms in a Cohort of Patients with Inflammatory Bowel Disease. Nutrients 2022; 15:nu15010169. [PMID: 36615826 PMCID: PMC9824626 DOI: 10.3390/nu15010169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 12/20/2022] [Accepted: 12/21/2022] [Indexed: 12/31/2022] Open
Abstract
The coronavirus disease (COVID-19) pandemic represents a global health challenge, particularly considering concomitant diseases. Patients with inflammatory bowel diseases (IBD) can be considered a population at risk. On the other hand, the risk of developing IBD and COVID-19 have both been described as modulated by vitamin D (VD) levels. In this work, a cohort of 106 adult patients affected by IBD was prospectively enrolled, during the second wave of the pandemic in Italy. In these patients, VD plasma levels, demographic, and clinical characteristics were tested for a correlation/an association with the risk of infection with SARS-CoV-2 in the study period (anti-spike IgG positivity) and the severity of COVID-19 symptoms. By multivariate logistic regression analysis, VD supplementation (Odds Ratio; OR 0.116, p = 0.002), therapy with monoclonal antibodies (OR 0.227, p = 0.007), and the use of mesalazine (OR 2.968, p = 0.046) were found to be independent predictors of SARS-CoV-2 positivity. Moreover, hypertension was associated with severe disease (p = 0.019), while a VD level higher than 30 ng/mL (p = 0.031, OR 0.078) was associated with asymptomatic infection. No interplay between IBD activity and COVID-19 risk of infection or symptoms was observed. These results confirm the importance of VD levels in defining the risk of COVID-19 and give encouraging data about the safety of maintaining immunomodulatory treatments for IBD during the COVID-19 pandemic.
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Affiliation(s)
- Amedeo De Nicolò
- Laboratory of Clinical Pharmacology and Pharmacogenetics, Department of Medical Sciences, University of Turin, 10149 Turin, Italy
- Correspondence: ; Tel.: +39-0114393867
| | - Jessica Cusato
- Laboratory of Clinical Pharmacology and Pharmacogenetics, Department of Medical Sciences, University of Turin, 10149 Turin, Italy
| | - Cristina Bezzio
- Gastroenterology Unit, Rho Hospital, ASST Rhodense, 20017 Milan, Italy
| | - Simone Saibeni
- Gastroenterology Unit, Rho Hospital, ASST Rhodense, 20017 Milan, Italy
| | - Marta Vernero
- Gastroenterology Unit, Department of Medical Sciences, University of Turin, 10126 Turin, Italy
| | - Michela Disabato
- Gastroenterology Unit, Department of Medical Sciences, University of Turin, 10126 Turin, Italy
| | - Gian Paolo Caviglia
- Gastroenterology Unit, Department of Medical Sciences, University of Turin, 10126 Turin, Italy
| | - Alice Ianniello
- Laboratory of Clinical Pharmacology and Pharmacogenetics, Department of Medical Sciences, University of Turin, 10149 Turin, Italy
| | - Alessandra Manca
- Laboratory of Clinical Pharmacology and Pharmacogenetics, Department of Medical Sciences, University of Turin, 10149 Turin, Italy
| | - Antonio D’Avolio
- Laboratory of Clinical Pharmacology and Pharmacogenetics, Department of Medical Sciences, University of Turin, 10149 Turin, Italy
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6
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Risk Factors for COVID-19 in Inflammatory Bowel Disease: A National, ENEIDA-Based Case-Control Study (COVID-19-EII). J Clin Med 2022; 11:jcm11247540. [PMID: 36556155 PMCID: PMC9785640 DOI: 10.3390/jcm11247540] [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: 09/18/2022] [Revised: 11/26/2022] [Accepted: 12/12/2022] [Indexed: 12/24/2022] Open
Abstract
(1) Scant information is available concerning the characteristics that may favour the acquisition of COVID-19 in patients with inflammatory bowel disease (IBD). Therefore, the aim of this study was to assess these differences between infected and noninfected patients with IBD. (2) This nationwide case−control study evaluated patients with inflammatory bowel disease with COVID-19 (cases) and without COVID-19 (controls) during the period March−July 2020 included in the ENEIDA of GETECCU. (3) A total of 496 cases and 964 controls from 73 Spanish centres were included. No differences were found in the basal characteristics between cases and controls. Cases had higher comorbidity Charlson scores (24% vs. 19%; p = 0.02) and occupational risk (28% vs. 10.5%; p < 0.0001) more frequently than did controls. Lockdown was the only protective measure against COVID-19 (50% vs. 70%; p < 0.0001). No differences were found in the use of systemic steroids, immunosuppressants or biologics between cases and controls. Cases were more often treated with 5-aminosalicylates (42% vs. 34%; p = 0.003). Having a moderate Charlson score (OR: 2.7; 95%CI: 1.3−5.9), occupational risk (OR: 2.9; 95%CI: 1.8−4.4) and the use of 5-aminosalicylates (OR: 1.7; 95%CI: 1.2−2.5) were factors for COVID-19. The strict lockdown was the only protective factor (OR: 0.1; 95%CI: 0.09−0.2). (4) Comorbidities and occupational exposure are the most relevant factors for COVID-19 in patients with IBD. The risk of COVID-19 seems not to be increased by immunosuppressants or biologics, with a potential effect of 5-aminosalicylates, which should be investigated further and interpreted with caution.
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Kwon HJ, Panagos K, Alizadeh M, Bell M, Bourmaf M, Zisman E, Paul P, Sibel L, Wong U. Patients with inflammatory bowel disease are more hesitant about Coronavirus disease 2019 vaccination. Front Med (Lausanne) 2022; 9:1005121. [PMID: 36457565 PMCID: PMC9707735 DOI: 10.3389/fmed.2022.1005121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 10/12/2022] [Indexed: 11/16/2022] Open
Abstract
Despite the impact of the Coronavirus Disease 2019 (COVID-19) pandemic, vaccine hesitancy remains common in the general public and patients with Inflammatory Bowel Diseases (IBD). We sought to examine the reasons for vaccine hesitancy in patients with IBD. In this case-control study, we performed a retrospective chart review of 1,349 IBD patients and 215 non-IBD patients seen at University of Maryland Medical Center, a tertiary referral medical center, between March 2020 and October 2021. Data obtained included demographics, vaccination records, disease history, number of IBD-related surgeries, and IBD medications. 813/1,349 (60.3%) IBD patients received at least one dose of either the Pfizer/BioNTech, Moderna, or Johnson & Johnson vaccines. In a multivariate logistic regression, COVID vaccination was found to be positively associated with older age (p-value = 1.65e-5), female sex (p = 0.00194), Asian and White races (p = 0.02330, 0.00169), number of clinic visits (p = 1.11e-08), and biologic use (p = 7.82e-5). There was no association between vaccination and other types of vaccination nor with the use of other IBD medications. There was a negative association between vaccination status and the total number of IBD related surgeries (p = 0.02857). In non-IBD patients, only the number of clinic visits was positively associated with COVID-19 vaccination. Although the majority of IBD patients are immunosuppressed, COVID-19 vaccination rate was only 60.3%. Younger adults, males, African Americans, and those requiring IBD-related surgeries were less likely to receive COVID-19 vaccine. Healthcare providers need to recognize these potential risk factors for COVID-19 vaccine hesitancy.
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Affiliation(s)
- Hyuk Joon Kwon
- Department of Internal Medicine, University of Maryland Medical Center, Baltimore, MD, United States
| | - Katherine Panagos
- Department of Internal Medicine, University of Maryland Medical Center, Baltimore, MD, United States,*Correspondence: Katherine Panagos
| | - Madeline Alizadeh
- Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Mack Bell
- Department of Internal Medicine, University of Maryland Medical Center, Baltimore, MD, United States
| | - Mohammad Bourmaf
- Department of Internal Medicine, University of Maryland Medical Center, Baltimore, MD, United States
| | - Erin Zisman
- Department of Internal Medicine, University of Maryland Medical Center, Baltimore, MD, United States
| | - Pinkle Paul
- Department of Internal Medicine, University of Maryland Medical Center, Baltimore, MD, United States
| | - Lauren Sibel
- Department of Internal Medicine, University of Maryland Medical Center, Baltimore, MD, United States
| | - Uni Wong
- Department of Gastroenterology and Hepatology, University of Maryland School of Medicine, Baltimore, MD, United States,Department of Gastroenterology and Hepatology, Veterans Affairs Maryland Health Care System, Baltimore, MD, United States
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Festa S, De Biasio F, Aratari A, Papi C. Intentional treatment with tofacitinib in a patient with severe refractory ulcerative colitis and concomitant Sars-CoV-2 infection. Dig Liver Dis 2022; 54:1598-1599. [PMID: 36137935 PMCID: PMC9444495 DOI: 10.1016/j.dld.2022.08.038] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 08/24/2022] [Accepted: 08/26/2022] [Indexed: 12/30/2022]
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Macedo Silva V, Lima Capela T, Freitas M, Cúrdia Gonçalves T, Boal Carvalho P, Dias de Castro F, João Moreira M, Cotter J. Humoral Immunogenicity After Vaccination Against SARS-CoV-2 Infection in Inflammatory Bowel Disease Patients Under Immunosuppressive Therapy: Should We Prioritize an Additional Booster Injection? Inflamm Bowel Dis 2022; 29:268-273. [PMID: 36099059 PMCID: PMC9494374 DOI: 10.1093/ibd/izac187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection may lead to the development of the novel coronavirus disease (coronavirus disease 2019 [COVID-19]). Scarce data are available regarding safety and efficacy of SARS-CoV-2 vaccination in inflammatory bowel disease (IBD) patients, which may present differences between subgroups. Lower humoral immunological response could require additional booster injections. METHODS This is a prospective study including adult patients with IBD after complete vaccination against SARS-CoV-2 infection with BioNTech vaccine. Patients with previous SARS-CoV-2 infection were excluded. A control group with healthy individuals matched for age and sex was also analyzed. Blood samples were collected 30 days after complete vaccination to quantify immunoglobulin G (IgG) antibody titers against SARS-CoV-2 in both groups. RESULTS The final sample included 81 IBD and 32 non-IBD patients, 55 (48.7%) of them women, with a mean age of 40.2 ± 13.0 years. From IBD patients, 58 (71.6%) had Crohn's disease and 23 (28.4%) had ulcerative colitis. IBD patients had significantly lower median anti-SARS-CoV-2 IgG levels when compared with the control group (6479 [interquartile range (IQR) 1830-11883, 10 053] AU/mL vs 13 061 [IQR 2826-21427, 15 539] AU/mL; P = .003). Regarding IBD medication, significant lower levels of SARS-CoV-2 IgG antibodies when compared with control subjects were observed in patients treated with thiopurines (5423 [IQR 3109-13369, 10 260] AU/mL; P = .011), methotrexate (834 [IQR 507-3467, 4155] AU/mL; P = .002), anti-tumor necrosis factor α agents (5065 [IQR 1033-11669, 10 636] AU/mL; P = .001), and corticosteroids (548 AU/mL; P = .001). The incidence of SARS-CoV-2 infection after vaccination was also significantly higher in patients treated with these agents. CONCLUSIONS IBD patients treated with immunomodulators, anti-tumor necrosis factor α agents and corticosteroids presented significantly lower anti-SARS-CoV-2 IgG levels following complete vaccination when compared with healthy control subjects. These findings support the benefit of additional booster injections in this population.
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Affiliation(s)
- Vítor Macedo Silva
- Address correspondence to: Vítor Macedo Silva, MD, Hospital da Senhora da Oliveira, Rua dos Cutileiros, Creixomil. 4835-044, Guimarães, Portugal ()
| | - Tiago Lima Capela
- Gastroenterology Department, Hospital da Senhora da Oliveira, Guimarães, Portugal,Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga, Portugal,Life and Health Sciences Research Institute/3B’s – Research Institute on Biomaterials, Biodegradables and Biomimetics, PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Marta Freitas
- Gastroenterology Department, Hospital da Senhora da Oliveira, Guimarães, Portugal,Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga, Portugal,Life and Health Sciences Research Institute/3B’s – Research Institute on Biomaterials, Biodegradables and Biomimetics, PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Tiago Cúrdia Gonçalves
- Gastroenterology Department, Hospital da Senhora da Oliveira, Guimarães, Portugal,Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga, Portugal,Life and Health Sciences Research Institute/3B’s – Research Institute on Biomaterials, Biodegradables and Biomimetics, PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Pedro Boal Carvalho
- Gastroenterology Department, Hospital da Senhora da Oliveira, Guimarães, Portugal,Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga, Portugal,Life and Health Sciences Research Institute/3B’s – Research Institute on Biomaterials, Biodegradables and Biomimetics, PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Francisca Dias de Castro
- Gastroenterology Department, Hospital da Senhora da Oliveira, Guimarães, Portugal,Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga, Portugal,Life and Health Sciences Research Institute/3B’s – Research Institute on Biomaterials, Biodegradables and Biomimetics, PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Maria João Moreira
- Gastroenterology Department, Hospital da Senhora da Oliveira, Guimarães, Portugal,Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga, Portugal,Life and Health Sciences Research Institute/3B’s – Research Institute on Biomaterials, Biodegradables and Biomimetics, PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - José Cotter
- Gastroenterology Department, Hospital da Senhora da Oliveira, Guimarães, Portugal,Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga, Portugal,Life and Health Sciences Research Institute/3B’s – Research Institute on Biomaterials, Biodegradables and Biomimetics, PT Government Associate Laboratory, Braga/Guimarães, Portugal
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Risk of adverse outcomes in inflammatory bowel disease patients infected with SARS-CoV-2: a systematic review and meta-analysis. Int J Colorectal Dis 2022; 37:2277-2289. [PMID: 36271206 PMCID: PMC9589854 DOI: 10.1007/s00384-022-04265-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/06/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Between people with and without inflammatory bowel disease (IBD), there was no statistically significant difference in the probability of contracting the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). However, the risk of adverse outcomes in IBD patients after virus infection remains unclear. METHODS Eligible studies conducted from January 1, 2020 to March 17, 2022 were obtained by searching PubMed, Embase, and Web of Science. Information was collected in tables from the included studies. Random-effects and fixed-effects models were used as measures for the pooled estimates. All data were estimated by R version 4.1.3. RESULTS Twenty-four studies were included. The risk ratio (RR) of adverse outcomes in COVID-19 patients with IBD increased by 32% (RR 1.32; 95% CI 1.06-1.66) relative to COVID-19 patients without IBD. The RR of mortality was higher in COVID-19 patients with IBD from Europe (RR 1.72; 95% CI 1.11-2.67) than in those that were not from Europe (RR 1.00; 95% CI 0.79-1.26; χ2 = 4.67; P = 0.03). Patients with ulcerative colitis were at higher risk of adverse outcomes after SARS-CoV-2 infection than patients with Crohn's disease patients (RR1.38; 95% CI 1.27-1.50). The IBD drugs treatment was associated with the risk of adverse outcomes, the pooled odds ratio (OR) of mesalazine (1.79; 95% CI 1.59-2.02), immunomodulators (1.30; 95% CI 1.10-1.53), and anti-TNF (0.47; 95% CI 0.41-0.53) were assessed. CONCLUSION COVID-19 patients with IBD had an increased risk of adverse outcomes than those without IBD, whereas anti-TNF treatment might reduce the risk.
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