Low incidence of SARs-CoV-2 among IBD patients on biologic therapy
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Investigators found a low incidence of SARs-CoV-2 among patients with inflammatory bowel disease who were taking biologic therapy, according to recently published data in the Journal of Gastroenterology and Hepatology.
“Ultimately, the relatively low incidence of SARS-CoV-2 in IBD patients having biologic therapy may provide some reassurance to patients and clinicians for the continuation of these treatment methods,” Ming Hui Lee, MD, from the department of biological sciences, faculty of science at the National University of Singapore, and colleagues wrote. “Regardless, further studies on larger populations of IBD patients are needed to clarify the risks of biologics on SARS-CoV-2 incidence in IBD patients as well as in other medical conditions treated with biologics.”
In a systematic review, Lee and colleagues used Pubed, Embase and China National Knowledge Infrastructure databases to identify 183 articles that discussed the incidence of COVID-19 in patients with IBD. They ultimately reviewed 43 articles and included 10 in their final analysis. The investigators collected information regarding those patients diagnosed with SARS-CoV-2, then performed a sensitivity analysis that included only patients diagnosed from reverse transcriptase-polymerase chain reaction (RT-PCR).
Of 249,095 patients, 309 patients with IBD tested positive for SARs-CoV-2. Additionally, of the 5,098 patients who were receiving biologic treatment, four patients tested positive for the infection. The average pooled incidence infection was 1.93 per 1,000 patients with IBD (95% CI; 0.48-7.77) and 0.68 infection per 1,000 patients with IBD who take biologics (95% CI; 0.26-1.82). In the sensitivity analysis that included RT-PCR diagnosis only, the rate of infections increased to 4.424 per 1,000 patients with IBD (95% CI; 3.82-4.7) for overall infections and 1.14 (95% CI, 0.01-94.22) for patients taking biologics.
“Existing guidelines on the clinical management of IBD patients in the COVID-19 pandemic recommend that IBD patients treated with anti-TNF, tofacitinib, ustekinumab and vedolizumab should continue with their existing therapy though it is unclear if these biologics increase the risk of SARS-CoV-2 infection, due to the possible risks of flares and disease exacerbation from biologics withdrawal in IBD patients with quiescent disease,” Lee and colleagues wrote.
Perspective
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The article is interesting and adds to what we already know. In patients with IBD on treatment, the researchers are not noting a higher percentage of patients developing COVID-19. When we are trying to interpret these numbers, we need to ask ourselves if these numbers are due to a patient’s behavior or treatment.
As IBD practitioners, we are monitoring the situation closely because one of our biggest concerns is the risk of immunomodulation given that IBD is an immune disease.
Now, in this world with COVID-19, we are trying to determine the risk of our patients having a bad outcome from that infection and trying to mediate that risk. So far, we are seeing that patients on therapy for IBD are not at an increased risk for COVID-19 infection or increased risk of having adverse outcomes with their treatments. We definitely want to continue treatment in patients because it keeps them healthy. This study gives us reassurance as the researchers are not seeing a markedly increased number in COVID-19 infections among IBD patients.
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