Inflammatory Bowel Disease Clinical Activity Is Associated with COVID-19 Severity Especially in Younger Patients

Ricciuto, Amanda; Lamb, Christopher A; Benchimol, Eric I; Walker, Gareth J; Kennedy, Nicholas A; Kuenzig, M Ellen; Kaplan, Gilaad G; Kappelman, Michael D; Ungaro, Ryan C; Colombel, Jean-Frederic; Brenner, Erica J; Agrawal, Manasi; Reinisch, Walter; Griffiths, Anne M; Sebastian, Shaji

BACKGROUND AND AIMS: Age is a major prognostic factor for COVID-19 outcomes. The effect of IBD activity on COVID-19 is unclear. We examined the relationship between IBD activity and COVID-19 severity according to age. METHODS: We included IBD patients diagnosed with COVID-19, reported to SECURE-IBD between March 13, 2020-August 3, 2021. Clinical IBD activity was measured by Physician Global Assessment (PGA). COVID-19-related outcomes were 1) ICU, ventilation, or death, and 2) hospitalization. Using generalized estimating equations, we determined adjusted odds ratios (aOR, 95% CI) for moderate and severe PGA vs. clinical remission/mild PGA, controlling for demographics, medications, and COVID-19 diagnosis period. We performed stratified analyses by age (≤50 vs. >50 years. RESULTS: Among 6,078 patients, adverse COVID-19 outcomes were more common with active IBD: ICU/ventilation/death in 3.6% (175/4898) of remission/mild, 4.9% (45/920) of moderate, 8.8% (23/260) of severe (p<0.001); hospitalization in 13% (649/4898) of remission/mild, 19% (178/920) of moderate, 38% (100/260) of severe (p<0.001). Stratified by decade, effect sizes were larger for younger patients. In patients ≤50 years, severe PGA was independently associated with ICU/ventilation/death (aOR 3.27 [1.15-9.30]) and hospitalization (aOR 4.62 [2.83-7.55]). In contrast, severe PGA was not independently associated with COVID-19 outcomes in those older than 50 years. CONCLUSIONS: Clinically active IBD may be a risk factor for severe COVID-19, particularly in younger patients. IBD disease control, including through medication compliance, and strategies to mitigate the risk of COVID-19 infection amongst patients with active IBD (e.g., distancing, immunization) are key to limit adverse COVID-19 outcomes.