‘Very reassuring’: Early data find low risk for poor COVID-19 outcomes in IBD
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Individuals with inflammatory bowel disease are not at increased risk for severe complications from COVID-19 infection, according to data presented at the Basic and Clinical Immunology for the Busy Clinician symposium.
Ryan Ungaro, MD, MS, associate professor of gastroenterology at Mount Sinai Hospital, in New York, provided a soup-to-nuts overview of data for IBD patients in the COVID-19 setting. The talk covered risk of acquiring the infection; risk for severe complications upon acquisition; the impact of IBD medications on COVID-19 infection; the possibility of IBD flares upon infection; and information on vaccines. “There was a real concern about our IBD patients being at increased risk,” he said.
Regarding acquisition risk, Ungaro suggested that early data have been encouraging. “The punchline is that it does not appear that IBD patients are at increased risk of getting COVID-19,” he said. “That is very reassuring.”
The talk then moved to risk for “bad outcomes” — which Ungaro described as hospitalization or mortality — for IBD patients who contract COVID-19. A 2020 study published in Gastroenterology involving 200 patients with IBD and some 20,000 individuals from the general population showed that there was no difference between the two groups with regard to these bad outcomes. “Other studies have reaffirmed this,” Ungaro said.
That said, subgroups of IBD patients required further attention, according to Ungaro. He noted that the SECURE-IBD database has been accruing patients from the outset of the pandemic. Findings from this database are showing that, as in the general population, older age was the most important risk factor for hospitalization or death from COVID-19 in IBD. “Also, people with multiple comorbidities were at risk, such as IBD and diabetes or IBD and chronic kidney disease,” he said, noting that those groups were at two- or three-fold risk for complications from the virus.
Turning to medication risks, Ungaro noted that IBD patients receiving corticosteroids were two or four times as likely to experience hospitalization or mortality from the virus. “Not surprisingly, corticosteroids are a bad actor in COVID-19 infections,” he said.
The news is better for other medications, including interleukin-12/23 inhibitors, TNF inhibitors and integrin antagonists, which showed either no risk or even a protective effect, according to Ungaro. “It is safe, keep taking your biologics, you are at no increased risk of getting sick,” he said.
Similarly, mesalamines also failed to show an increased risk for COVID complications in the IBD setting.
Regarding drug combinations, Ungaro suggested that there is a range of risks. For example, methotrexate plus azathioprine may yield complications from COVID-19, but MTX with a TNF inhibitor likely will not.
The impact of COVID-19 infection on IBD disease activity was another concern for clinicians like Ungaro. While roughly one-quarter of patients will experience new GI symptoms upon infection, no significant increase in disease activity was reported at 6 months, according to two studies in IBD Journal and Clinical Gastroenterology and Hepatology. “COVID-19 does not appear to be a trigger for IBD flares,” Ungaro said.
The last topic Ungaro covered was vaccines in the IBD setting. “Data and guidance on vaccines in IBD patients has generated a lot of flux and created a lot of confusion in people,” he acknowledged.
That said, early data from Boyarsky and colleagues in JAMA comparing IBD and non-IBD populations have shown that vaccine response rates are similar. “It is reassuring that early on, many of our patients are getting a good response,” he said.
However, at 3 weeks, the response was “blunted” in some patients. In addition, patients on TNF inhibitors experienced a “decay” in antibody response by 14 to 18 weeks post-vaccination, according to Ungaro.
“We are currently considering extra doses,” he said. “But we need more data.”
As a final point, Ungaro stressed that COVID-19 vaccines yielded no risk of IBD flare. “This, too, was very reassuring,” he said.
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Ungaro R. IBD and COVID-19. Presented at Basic and Clinical Immunology for the Busy Clinician; Feb. 26, 2022. (virtual meeting).
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