Research updates about COVID-19 and IBD

COVID-19 has brought uncertainty and question around the world, but especially for those living with Crohn’s disease or ulcerative colitis. With COVID-19 spiking again around the country, we wanted to remind you what we already know about IBD and COVID-19 and share with you some of the latest research about COVID-19 in IBD. 

Generally, IBD patients are not at higher risk for COVID-19. Your risk depends on a variety of factors, including your age, if you are pregnant or had a recent pregnancy, whether you have other diseases (heart, lung, or diabetes), or if you are taking steroids. If you are concerned about whether you are considered high risk, we encourage you to talk to your doctor. The best thing you can be doing right now is taking precautions to protect yourself and your loved ones, staying on your medication as prescribed, and staying in contact with your healthcare provider if you do come down with COVID-19. 

According to Surveillance Epidemiology of Coronavirus Under Research Exclusion (SECURE-IBD), an international, pediatric and adult registry to monitor and report on outcomes of COVID-19 occurring in IBD patients, there have been 3,195 reported cases of COVID-19 in IBD patients in 61 countries. The data from SECURE-IBD has yielded important discoveries and understandings about COVID-19 and IBD:

• Early data from the database published in Gastroenterology showed that there is no impact on risk of severe COVID-19 among those taking TNF antagonists like infliximab (Remicade), adalimumab (Humira), certolizumab pegol (Cimzia), and golimumab (Simponi).
• A study published in Gut showed that patients on thiopurines alone or in combination with another drug are associated with higher risk of severe COVID-19 compared to those on TNF antagonists alone.
• Research published in Clinical Gastroenterology and Hepatology analyzed data from SECURE-IBD and the PORTO group of COVID-19 in pediatric IBD patients and found that pediatric patients have very low risk of developing severe COVID-19. Additionally, the study showed that TNF antagonists were associated with decreased risk of hospitalization among pediatric IBD patients with COVID-19.

In addition to the SECURE-IBD research, several studies have been published in Inflammatory Bowel Diseases and Crohn’s & Colitis 360 that provide a deeper understanding of the impact of COVID-19 on IBD patients around the world:

• A study from earlier this year suggested that IBD patients, including those on immunosuppressants, were not contracting COVID-19 at a higher rate than the non-IBD population. From the early data reported, most cases were mild with minimal cases requiring admittance to the ICU. This study offers advice for IBD patients to adhere to the same infection control protocol as is the standard for the general population of hand washing, minimizing contact with others, utilizing delivery services for food and medication, and telemedicine for health visits whenever possible. The study did note that it is believed that the use of steroids could increase the risk of COVID-19 infection and to be mindful of this risk when discussing continued therapy with a medical professional.
• A survey of gastroenterologists who are members of the Spanish Working Group on Crohn’s Disease and Colitis looked at how COVID-19 changed the practice of if IBD treatments and diagnosis, as well as the treatment of COVID-19 in IBD patients during the pandemic. According to the study, 100% of hospitals surveyed canceled non-emergent in person consultations and transitioned care to telemedicine consultations. Additionally, non-emergent endoscopic procedures were delayed or canceled. The study also found that 96.1% of sites recommended that IBD patients without COVID-19 remain on immunosuppressants, with only 3.9% (two sites) lowering the immunosuppressant dose. All the surveys conducted also advised patients who were on a biologic therapy to continue treatment if they tested negative for COVID-19.
• A study of two hospitals in Greece examined how COVID-19 affected their IBD patients and continuation of care. According to the study, the hospitals were able to mitigate spread and continue IBD patient care by utilizing telemedicine, electronic prescriptions, home delivery of medications, isolation of infusion units and IBD clinics, and limiting endoscopic procedures to emergencies only. The study concluded that strict compliance with the recommended guidelines and swift action in implanting those guidelines was able to prevent a substantial impact to the IBD community from COVID-19 and maintain therapeutic care.
• Researchers from Italy highlight the challenges IBD patients faced at one hospital – Policlinico San Donato Research Hospital – in Milan. According to their study, their immediate reaction to the pandemic started with phone calls to patients to screen for symptoms before any consults or endoscopic procedures. All non-urgent care was postponed, and gastroenterologists were reassigned to assist with COVID-19 patient care. IBD patients were most concerned with delaying procedures related to IBD and risk of COVID-19 infection. While IBD patients did not appear to be at higher risk of developing COVID-19 compared with the general population, those with co-morbidities or long standing aggressive disease were still treated as very high risk for infection as a precaution. The same infection control standards were implemented (hand washing, social distancing, proper PPE) as with the general population, as well as relying heavily on telemedicine to conduct non-urgent IBD related consultations.

As the COVID-19 pandemic continues to evolve, we will share the most up-to-date information and research with you. You can find more research articles on COVID-19 and IBD here.

Jessie Sikora is a senior marketing manager for the Crohn's & Colitis Foundation.