Treat IBD ‘first and foremost’ in children who contract COVID-19
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Children with inflammatory bowel disease who contract COVID-19 generally have mild disease, according to study results.
In her presentation at Crohn’s and Colitis Congress, Erica J. Brenner, MD, from the University of North Carolina, said that her group’s findings show that in in this patient group, physicians should treat IBD “first and foremost.”
“The aims of this study were two define the impact of COVID-19 on children and adolescents with inflammatory bowel disease,” she said. “We wanted to evaluate associations between comorbidities, IBD characteristics, demographic characteristics and IBD treatment and COVID-19 outcomes.”
Researchers analyzed data from two databases, the SECURE-IBD and the COVID-19 database of the Pediatric IBD Porto group of the European Society for Pediatric Gastroenterology Hepatology and Nutrition, which both began in March 2020. They included all patients aged 18 years and younger through October 1, 2020.
The final analysis included 209 patients (46% girls; 66% Crohn’s disease). In the patient group, 59% were in remission, 22% had mild disease, 13% had moderate disease and 5% had severe disease at the time of infection. Most of the patients had no comorbidities other than IBD (89%).
Brenner said the outcomes among the patient group were “very reassuring,” with no deaths, 14 hospitalizations and two patients needing mechanical ventilation.
The researchers found that comorbid conditions (50% hospitalized vs. 12% not hospitalized; P < .01), moderate/sever IBD disease activity (64% vs. 15%; P < .01), gastrointestinal symptoms (71% vs. 19%; P < .01), steroid use (29% vs. 8%; P = .03) and sulfasalazine/mesalamine use (57% vs. 21%; P = .01) were associated with hospitalization.
Conversely, anti-TNF monotherapy was associated with decreased likelihood of hospitalization (P < .01).
Brenner said these findings are in line with preliminary COVID-19 guidance released last year on the treatment of pediatric patients with IBD.
“As in the general pediatric population, children who contract COVID-19 rarely develop severe illness, including Multisystem Inflammatory Syndrome in Children,” Brenner said. “It is generally safe for children with IBD to continue their medications during the pandemic. While corticosteroids can be used to treat relapses, they should really be weaned as soon as possible.”
Perspective
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Jacob Kurowski, MD
Brenner presented important findings surrounding the outcome and impact of infection with COVID-19 on children with IBD. This included investigation of factors such as IBD medications, demographics and IBD phenotype. Brenner and colleagues analyzed data from an international survey database, SECURE-IBD, and a database from the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition.
The analysis showed rates of hospitalization and mechanical ventilation were significantly lower in children with IBD than adults with IBD. These findings continue to be encouraging as adults are vaccinated, pediatric vaccine trials are on-going and the possibility of herd immunity looms.
However, these data likely represent the early and original COVID-19 strains so we need to remain vigilant with masking and social distancing, particularly as new and possibly more contagious strains arise. Further, while Multisystem Inflammatory Syndrome in Children (MIS-C) is a rare complication, it does result in severe illness with hospitalization requiring significant medical intervention.
It is also important to recognize the prevalence of GI symptoms with COVID-19 infection in our young patients with IBD. GI symptoms that may mimic a disease exacerbation rather than the classic respiratory symptoms were a significant risk factor for the need for hospitalization. This complication of COVID-19 may disproportionately affect patients with IBD as appropriately highlighted in Brenner’s findings.
In agreement with Brenner’s presentation, I recommend and encourage my patients to continue their maintenance therapy during the COVID-19 pandemic as anti-TNF therapy has not been found to be a significant risk factor for severe COVID-19 infection in children or adults with IBD.
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Brenner EJ. “IBD-related care in the era of COVID-19: Pediatric update.” Presented at: Crohn’s and Colitis Congress. Jan. 21-24, 2020.
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