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Cited by 674COVID-19 Clinical Research StudiesInflammatory Bowel DiseaseRheumatoid Arthritis Research and Therapies

Corticosteroids, But Not TNF Antagonists, Are Associated With Adverse COVID-19 Outcomes in Patients With Inflammatory Bowel Diseases: Results From an International Registry

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Brenner, Erica J., Ungaro, Ryan C., Gearry, Richard B., Kaplan, Gilaad G., Kissous-Hunt, Michele, Lewis, James D., Ng, Siew C., Rahier, Jean-Francois +7 more·2020·Gastroenterology
DOI 10.1053/j.gastro.2020.05.032PMC PMC7233252
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Abstract

Background and aims The impact of Coronavirus disease 2019 (COVID-19) on patients with inflammatory bowel disease (IBD) is unknown. We sought to characterize the clinical course of COVID-19 among patients with IBD and evaluate the association among demographics, clinical characteristics, and immunosuppressant treatments on COVID-19 outcomes.Methods Surveillance Epidemiology of Coronavirus Under Research Exclusion for Inflammatory Bowel Disease (SECURE-IBD) is a large, international registry created to monitor outcomes of patients with IBD with confirmed COVID-19. We calculated age-standardized mortality ratios and used multivariable logistic regression to identify factors associated with severe COVID-19, defined as intensive care unit admission, ventilator use, and/or death.Results 525 cases from 33 countries were reported (median age 43 years, 53% men). Thirty-seven patients (7%) had severe COVID-19, 161 (31%) were hospitalized, and 16 patients died (3% case fatality rate). Standardized mortality ratios for patients with IBD were 1.8 (95% confidence interval [CI], 0.9-2.6), 1.5 (95% CI, 0.7-2.2), and 1.7 (95% CI, 0.9-2.5) relative to data from China, Italy, and the United States, respectively. Risk factors for severe COVID-19 among patients with IBD included increasing age (adjusted odds ratio [aOR], 1.04; 95% CI, 1.01-1.02), ≥2 comorbidities (aOR, 2.9; 95% CI, 1.1-7.8), systemic corticosteroids (aOR, 6.9; 95% CI, 2.3-20.5), and sulfasalazine or 5-aminosalicylate use (aOR, 3.1; 95% CI, 1.3-7.7). Tumor necrosis factor antagonist treatment was not associated with severe COVID-19 (aOR, 0.9; 95% CI, 0.4-2.2).Conclusions Increasing age, comorbidities, and corticosteroids are associated with severe COVID-19 among patients with IBD, although a causal relationship cannot be definitively established. Notably, tumor necrosis factor antagonists do not appear to be associated with severe COVID-19.

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  • Among SECURE-IBD patients over 60, 20% had a severe COVID-19 complication; older age (adjusted OR 1.04, 95% CI 1.01-1.06) and two or more comorbidities (adjusted OR 2.9, 95% CI 1.1-1.78) were linked to poor outcomes.

    “Among people over the age of 60 years who were reported in SECURE-IBD, 20% experienced a severe complication of COVID-19, with older age (adjusted OR 1.04, 95% CI 1.01–1.06) and two or more comorbidities (adjusted OR 2.9, 95% CI 1.1–1.78) associated with poor outcomes.”

    From The four epidemiological stages in the global evolution of inflammatory bowel disease (2021) · cites this paper as [97]

  • Advanced age is the main risk factor for severe COVID-19 complications in IBD patients.

    “The primary risk factor for a severe complication of COVID-19 — defined as ventilator use, intensive care unit admission or death — in patients with IBD is advanced age.”

    From The four epidemiological stages in the global evolution of inflammatory bowel disease (2021) · cites this paper as [97]

  • Older IBD patients are the most vulnerable during the COVID-19 pandemic.

    “Consequently, older people are the most vulnerable population with IBD during the pandemic97.”

    From The four epidemiological stages in the global evolution of inflammatory bowel disease (2021) · cites this paper as [97]

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Authors
Brenner, E. J., Ungaro, R. C., Gearry, R. B., Kaplan, G. G., Kissous-Hunt, M., Lewis, J. D., Ng, S. C., Rahier, J.-F., Reinisch, W., Ruemmele, F. M., Steinwurz, F., Underwood, F. E., Zhang, X., Colombel, J.-F., & Kappelman, M. D.
Affiliations
  • University of North Carolina at Chapel Hill (US)
  • Icahn School of Medicine at Mount Sinai (US)
  • University of Otago (NZ)
  • University of Calgary (CA)
  • University of Pennsylvania (US)
  • Chinese University of Hong Kong (HK)
  • Medical University of Vienna (AT)
  • Hôpital Necker-Enfants Malades (FR)
Corresponding author
  • Brenner, Erica J.
  • Ungaro, Ryan C.
ORCID
Venue
Gastroenterology
Publisher
Elsevier BV
Published
2020-08
Volume
159
Issue
2
Pages
481-491.e3
ISSN
0016-5085 (ISSN-L)
DOI
10.1053/j.gastro.2020.05.032
PMC
PMC7233252
OpenAlex
W3024177957
Cited by
674
References
28
Citations by year
2026: 7 · 2025: 14 · 2024: 43 · 2023: 66 · 2022: 148 · 2021: 251 · 2020: 144
FWCI
19.98
Type
journal article
Language
en
Open access
Licence
Locations
  • Gastroenterology (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • DIAL (Catholic University of Leuven) (submittedVersion, other-oa)
Funders
National Institutes of Health
Topics
  • Health Sciences › Medicine › Infectious Diseases › COVID-19 Clinical Research Studies
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Inflammatory Bowel Disease
  • Health Sciences › Medicine › Rheumatology › Rheumatoid Arthritis Research and Therapies
Keywords
COVID-19 pandemic, inflammatory bowel disease, systemic corticosteroids, TNF antagonists, sulfasalazine, 5-aminosalicylates, immunosuppressants, risk factors for severe COVID-19, mortality, comorbidities, age, intensive care unit admission, ventilator use, case fatality rate
MeSH terms
Betacoronavirus, Tumor Necrosis Factor Inhibitors, COVID-19, SARS-CoV-2, Adrenal Cortex Hormones, Adult, Aged, Critical Care, Female, Hospitalization, Humans, Immunosuppressive Agents, Male, Middle Aged, Pneumonia, Viral, Population Surveillance, Registries, Respiration, Artificial, Risk Factors, Sulfasalazine, Inflammatory Bowel Diseases, Comorbidity, Odds Ratio, Coronavirus Infections, Pandemics

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