The natural history of COVID-19 in patients with inflammatory bowel disease: a nationwide study by the Hellenic Society for the study of IBD

Bamias, Giorgos; Kokkotis, Georgios; Christidou, Angeliki; Christodoulou, Dimitrios K; Delis, Vasileios; Diamantopoulou, Georgia; Fessatou, Smaragdi; Gatopoulou, Anthia; Giouleme, Olga; Kafritsa, Panagiota; Kalantzis, Chrisostomos; Kapsoritakis, Andreas; Karatzas, Pantelis; Karmiris, Konstantinos; Katsanos, Konstantinos; Kevrekidou, Polyxeni; Kosmidis, Charalampos; Mantaka, Aikaterini; Mathou, Nicoletta; Michalopoulos, George; Michopoulos, Spyridon; Papaconstantinou, Ioannis; Papatheodoridis, George; Polymeros, Dimitrios; Potamianos, Spyros; Poulopoulos, Georgios; Protopapas, Andreas; Sklavaina, Maria; Soufleris, Konstantinos; Theocharis, Georgios; Theodoropoulou, Angeliki; Triantafillidis, John K; Triantafyllou, Konstantinos; Tsiolakidou, Georgia; Tsironi, Eftychia; Tzouvala, Maria; Viazis, Nikos; Xourgias, Vasileios; Zacharopoulou, Eirini; Zampeli, Evanthia; Mantzaris, Gerasimos J

OBJECTIVES: COVID-19 has evolved into a global health crisis, variably affecting the management of patients with chronic illnesses. Patients with inflammatory bowel disease (IBD) may represent a vulnerable population due to frequent administration of immune-modifying treatments. We aimed to depict the natural history of COVID-19 infection in Greek patients with IBD at a nationwide level via unbiased reporting of all cases that were registered during the sequential waves of the pandemic. METHODS: Following a national call from the Hellenic Society for the study of IBD, we enrolled all IBD patients with established diagnoses of COVID-19. Clinical and epidemiological data, including COVID-19 modifying factors and IBD-associated therapies, were analyzed against adverse outcomes (hospitalization, ICU admission and death). RESULTS: We identified 154 IBD patients who were diagnosed with COVID-19 (men: 58.4%; mean age=41.7 years [SD = 14.9]; CD: 64.3%). Adverse outcomes were reported in 34 patients (22.1%), including 3 ICU admissions (1.9%) and two deaths (1.3%). Multivariate logistic regression analysis showed that age (OR = 1.04, 95% CI, 1-1.08) and dyspnea at presentation (OR = 7.36, 95% CI, 1.84-29.46) were associated with worse outcomes of COVID-19 infection. In contrast, treatment with biologics, in particular anti-TNF agents, exerted a protective effect against an unfavorable COVID-19 disease course (OR = 0.4, 95% CI, 0.16-0.99). Patients on subcutaneous biologics were more likely to halt treatment due to the infection as compared to those on intravenous biologics. CONCLUSIONS: IBD patients who developed COVID-19 had a benign course with adverse outcomes being infrequent. Treatment with anti-TNF biologics had a protective effect, thus, supporting continuation of therapy during the pandemic.