P1656 - Association Between Medical Therapies for Inflammatory Bowel Disease and Severe COVID-19: A Systematic Review and Meta-Analysis

Monday, October 25, 2021

10:30 AM – 4:15 PM PT

Location: Shoreline Exhibit Hall

Has Audio

Presenting Author(s)

Mohammad Shehab, MBBCh, MRCP

Mubark Alkabeer University Hospital
Aljabreyah, Hawalli, Kuwait

Fatema Alrashed, PharmD, MSc, BCPS¹, Israa Abdullah, PharmD², Mohammad Shehab, MBBCh, MRCP²
¹MCPHS University, Boston, MA; ²Mubark Alkabeer University Hospital, Kuwait, Hawalli, Kuwait

Introduction: Inflammatory bowel disease (IBD) is a chronic inflammatory autoimmune condition at which patients require long-term maintenance medical therapies. During COVID-19 pandemic, safety of patients with IBD on medical therapy emerged as an area of concern. The aim of this study is to evaluate the association between IBD therapies and severe COVID-19.

Methods: Systematic review of all published studies from December, 1st 2019 to June 15th, 2021 was conducted to identified studies on COVID-19 outcomes (hospitalisation, need for intensive care unit (ICU) care and mortality) in patients with current treatment 5-aminosalicylic acid (5-ASA), immunomodulators (thiopurines, calcineurin inhibitors and methotrexate), steroids, biological agents (anti-tumour necrosis factor (TNF), vedolizumab, ustekinumab), combination therapy (anti-TNF plus an immunomodulator), or small molecule inhibitors for IBD. The proportion of patients who experienced severe outcomes and risk ratios (RR) were calculated.

Results: Meta-analysis of twenty-seven studies found that immunomodulators (RR=1.27, 95% CI: 1.01-1.6, p=0.04), corticosteroids (RR= 1.94, 95% CI: 1.67-2.26, p < 0.00001), and 5-ASA (RR=1.77, 95% CI: 1.52-2.06, p < 0.00001) increase the risk of hospitalization due COVID-19 in IBD patients. The proportion of IBD patients hospitalized for COVID-19 was highest in patients taking combination therapy (52%, 95% CI: 31-72). Corticosteroids and 5-ASA significantly increased the risk of ICU admission and mortality, whereas biological agents decreased the risk of hospitalization and mortality.

Discussion: In patients with IBD and COVID-19, the risk of hospitalization, ICU care and mortality is high among patients taking corticosteroids or 5-ASA. Immunomodulators and combination therapy increase the risk of hospitalization for patients with IBD. In contrast, the use of biological agents seems to be protective against severe outcomes.

Figure: Pooled proportion of patients with IBD and were hospitalized for COVID-19 stratified per drug group

*Study*	*Total number of patients with IBD+COVID-19 (n)*	*Study Design*	*Country*	*Mean Age*	*Male sex (n)*	*Ulcerative colitis (n)*	*Crohn's disease (n)*	*IBD undetermined*	*IBD Drug*
*Agrawal et al*	37	Observational	Multiple	42.2	22	30	6	NA	Tofacitinib
*Allocca et al*	15	Observational- cohort	France and Italy	39	4	9	6	NA	Corticosteroids, tacrolimus, everolimus, infliximab, Vedolizumab, Ustekinumab, Adalimumab, Mesalamine, Azathioprine
*Annapureddy et al*	93	Observational	USA	48	26	Not specified	Not Specified	NA	Biologics
*Attauabi et al*	76	Observational	Denmark	52.5	45	45	31	NA	5-ASA,topical steroids
*Axerlrad et al*	83	Observational	USA	35	44	27	56	NA	Corticosteroids Methotrexate, infliximab, Vedolizumab, Ustekinumab, Adalimumab, Mesalamine, Azathioprine
*Bezzio et al*	79	Observational	Italy	45	44	47	32	NA	Corticosteroids Methotrexate, infliximab, Vedolizumab, Ustekinumab, Adalimumab, Mesalamine, Azathioprine
*Bossa et al*	32	Observational	Italy	42.2	20	Not specified	Not specified	NA	Golimumba, infliximab, Vedolizumab, Ustekinumab, Adalimumab
*Brenner et al*	1830	Registery	Multiple	42.9	276	812	1010	NA	Corticosteroids, biologics,5-ASA, immunomodulators
*Bourgonje et al*	3	case report	Netherlands	33	2	3	0	NA	5-ASA
*Conley et al*	203	Observational	UK	42	65	98	105	NA	Corticosteroids, biologics, immunomodulators
*Derikx et al*	96	Observational)	Netherlands	62.5	46	59	36	NA	Corticosteroids, biologics,5-ASA, immunomodulators, Tofacitinib
*Gubatan et al*	5	Observational	USA- California	70.6	2	3	2	0	corticosteroid, 5-ASA, 6MP/azathiprine, methotrexate, vedolizumab, ustekinumab, tofacitinib, anti-TNF
*Kennedy et al*	590	Observational	UK	not specified	not specified	not specified	not specified	NA	infliximab, vedolizumab
*Lamp et al*	211	Obervational	UK	59.5	116	109	86	16	5-ASA, prednisolone, thiopurine, vedolizumab, anti-TNF, biologics
*Lukin et al*	80	Observational	USA- New York	48.3	45	26	38	NA	biologics (anti-TNF, vedolizumab, ustekinumab),non-biologics (tofacitinib, dual (vedolizumab + tofacitinib), 6MP, azathioprine, methotrexate, corticosteroids, 5-ASA)
*Mazza et al*	1	Case report	Italy	80	0	1	0	NA	5-ASA
*Meyer et al*	600	Observational	France	50	not specified	not specified	not specified	NA	Biologics, immunomodulators
*Okeke et al*	1	Case report	USA	60	0	0	1	NA	Adalimumab and methotrexate
*Rizzello et al*	26	Observational	Italy	Not specified	Not specified	11	15	NA	Biologics and 5-ASA
*Rodríguez-Lago et al*	40	Observational	Spain	59	24	23	13	4	5-ASA
*SECURE-IBD*	6176	Data base	Multiple countries	Not specified	2699	2597	3539	NA	Corticosteroids Methotrexate, infliximab, Vedolizumab, Ustekinumab, Adalimumab, 5-ASA, Azathioprine, Tofacitnib
*Singh et al*	232	Observational	USA	51.2	85	93	101	38	Corticosteroids
*Taxonera et al*	12	Observational	Spain	52	3	5	7	NA	Biologics, 5-ASA, immunomodulators
*Tursi et al*	1	Case report	Italy	30	1	1	0	NA	adalimumab plus mesalazine
*Unagaro et al*	1439	Observational	Multiple countries	44.1	734	643	795	NA	Anti-TNF biologics, Thiopurine, 5-ASA
*Vadan et al*	7	Observational	Italy	44.5	5	4	3	NA	Corticosteroids, biologics, immunomodulators
*Vechi et al*	1	Case report	Brazil	36	0	0	1	NA	Adalimumab

Table: Table showing included studies's design and patient's characteristics

Disclosures:
Fatema Alrashed indicated no relevant financial relationships.
Israa Abdullah indicated no relevant financial relationships.
Mohammad Shehab indicated no relevant financial relationships.

Fatema Alrashed, PharmD, MSc, BCPS¹, Israa Abdullah, PharmD², Mohammad Shehab, MBBCh, MRCP². P1656 - Association Between Medical Therapies for Inflammatory Bowel Disease and Severe COVID-19: A Systematic Review and Meta-Analysis, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.