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COVID-19 and Outcomes in Patients With Inflammatory Bowel Disease: Systematic Review and Meta-Analysis
Kartikeya Tripathi1, Gala Godoy Brewer2, Minh Thu Nguyen3
1University of Massachusetts Medical School, Baystate Campus, Springfield, MA, USA.
Insights
The prevalence of coronavirus disease 2019 (COVID-19) in inflammatory bowel disease (IBD) patients was low. Anti-tumor necrosis factor (anti-TNF) therapy correlated with better outcomes, unlike corticosteroids or mesalamine, which were linked to worse results.
Area of Science:
- Gastroenterology
- Infectious Diseases
- Immunology
Background:
- The impact of coronavirus disease 2019 (COVID-19) on patients with inflammatory bowel diseases (IBD) is a critical area of ongoing research.
- Understanding the epidemiological and clinical implications for this vulnerable population is essential for guiding patient care.
Purpose of the Study:
- To conduct a systematic review and meta-analysis investigating the epidemiology, clinical characteristics, and outcomes of COVID-19 in IBD patients.
- To compare outcomes based on different IBD treatment modalities.
Main Methods:
- A comprehensive literature search was performed across multiple databases (PubMed, EMBASE, Cochrane Central, etc.) up to October 2020.
- Studies including IBD patients with confirmed COVID-19 were analyzed for prevalence, patient characteristics, IBD treatments, comorbidities, hospitalization, ICU admission, and mortality.
- Meta-analysis was used to compare outcomes based on therapies such as anti-tumor necrosis factor (anti-TNF), corticosteroids, mesalamine, and immunomodulators.
Main Results:
- The study included 23 studies with 51,643 IBD patients, of whom 1449 had COVID-19. The overall prevalence of COVID-19 in IBD patients was 1.01%.
- Patients treated with anti-tumor necrosis factor (anti-TNF) therapy showed a significantly lower risk of hospitalization and ICU admission compared to those on corticosteroids or mesalamine.
- No significant difference in outcomes was observed between patients on immunomodulators versus those on mesalamine or anti-TNF therapy.
Conclusions:
- The prevalence of COVID-19 among IBD patients is low.
- Corticosteroid or mesalamine use was associated with adverse outcomes, while anti-TNF therapy correlated with more favorable outcomes in IBD patients with COVID-19.
- Further research is needed to elucidate the mechanisms behind these differential outcomes and to develop strategies for risk mitigation.
Background:
Our understanding of coronavirus disease 2019 (COVID-19) and its implications for patients with inflammatory bowel diseases (IBD) is rapidly evolving. We performed a systematic review and meta-analysis to investigate the epidemiology, clinical characteristics, and outcomes in IBD patients with COVID-19.
Methods:
We searched PubMed, EMBASE, Cochrane Central, Clinicaltrials.gov, Web of Science, MedRxiv, and Google Scholar from inception through October 2020. We included studies with IBD patients and confirmed COVID-19. Data were collected on the prevalence, patient characteristics, pre-infection treatments for IBD, comorbidities, hospitalization, intensive care unit (ICU), admission, and death.
Results:
Twenty-three studies with 51,643 IBD patients and 1449 with COVID-19 met our inclusion criteria. In 14 studies (n = 50,706) that included IBD patients with and without COVID-19, the prevalence of infection was 1.01% (95% confidence interval [CI], 0.92-1.10). Of IBD patients with COVID-19, 52.7% had Crohn's disease, 42.2% had ulcerative colitis, and 5.1% had indeterminate colitis. Nine studies (n = 687) reported outcomes according to IBD therapy received. Compared with patients on corticosteroids, those on antitumor necrosis factor (anti-TNF) therapy had a lower risk of hospitalization (risk ratio [RR], 0.24; 95% CI, 0.16-0.35; P < .01; I2 = 0%) and ICU admission (RR, 0.10; 95% CI, 0.03-0.37; P < .01) but not death (RR, 0.16; 95% CI, 0.02-1.71; P = .13; I2 = 39%). Compared with patients on mesalamine, those on antitumor necrosis factor therapy had a lower risk of hospitalizations (RR, 0.37; 95% CI, 0.25-0.54), ICU admissions (RR, 0.20; 95% CI, 0.07-0.58), and death (0.21; 95% CI, 0.04-1.00). Comparing patients on immunomodulators vs mesalamine or anti-TNF therapy, there was no difference in these outcomes.
Conclusions:
The prevalence of COVID-19 in IBD patients was low. Use of corticosteroids or mesalamine was significantly associated with worse outcomes, whereas use of anti-TNFs was associated with more favorable outcomes. Further investigation clarifying the mechanisms of these disparate observations could help identify risk and adverse outcome-mitigating strategies for patients with IBD.
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