Corticosteroids, but not TNF Antagonists, are Associated with Adverse COVID-19 Outcomes in Patients With Inflammatory Bowel Diseases: Results from an International Registry

Brenner, Erica J.; Ungaro, Ryan C.; Gearry, Richard B.; Kaplan, Gilaad G.; Kissous-Hunt, Michele; Lewis, James D.; Ng, Siew C.; Rahier, Jean-Francois; Reinisch, Walter; Ruemmele, Frank M.; Steinwurz, Flavio; Underwood, Fox E.; Zhang, Xian; Colombel, Jean-Frederic; Kappelman, Michael D.

Background and Aims The impact of Coronavirus disease 2019 (COVID-19) on patients with inflammatory bowel disease (IBD) is unknown. We sought to characterize the clinical course of COVID-19 among IBD patients and evaluate the association between demographics, clinical characteristics, and immunosuppressant treatments on COVID-19 outcomes. Methods Surveillance Epidemiology of Coronavirus Under Research Exclusion for Inflammatory Bowel Disease (SECURE-IBD) is a large, international registry created to monitor outcomes of IBD patients with confirmed COVID-19. We calculated age-standardized mortality ratios (SMRs) and utilized multivariable logistic regression to identify factors associated with severe COVID-19, defined as intensive care unit admission, ventilator use, and/or death. Results 525 cases from 33 countries were reported (Median age 43 years, 53% men). Thirty-seven patients (7%) had severe COVID-19, 161 (31%) were hospitalized, and 16 patients died (3% case fatality rate). SMRs for IBD patients were 1.8 (95% confidence interval [CI] 0.9-2.6), 1.5 (95% CI 0.7-2.2), and 1.7 (95% CI 0.9-2.5) relative to data from China, Italy, and the US, respectively. Risk factors for severe COVID-19 among IBD patients included increasing age (adjusted odds ratio [aOR] 1.04, 95% CI 1.01-1.02), ≥2 comorbidities (aOR 2.9, 95% CI 1.1-7.8), systemic corticosteroids (aOR 6.9, 95% CI 2.3-20.5), and sulfasalazine or 5-aminosalicylate use (aOR 3.1, 95% CI 1.3-7.7). TNF antagonist treatment was not associated with severe COVID-19 (aOR 0.9, 95% CI 0.4-2.2). Conclusions Increasing age, comorbidities, and corticosteroids are associated with severe COVID-19 among IBD patients, although a causal relationship cannot be definitively established. Notably, TNF antagonists do not appear to be associated with severe COVID-19.