20.05.2020

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

Prognosis Hepato-gastroenterology
Brenner EJ et al
Gastroenterology

Main result

A total of 525 Covid-19 patients with chronic inflammatory bowel disease from 33 countries were included, with a median age of 43 years old, 53% of whom were male.
37 (7%) had a severe infection, 161 (31%) were hospitalized and 16 died.
The standardized mortality rate was 1.8 (CI [0.9-2.6]), 1.5 (CI [0.7-2.2]), and 1.7 (CI [0.9-2.5]) in China, Italy, and the United States, respectively.
Risk factors for the severity of Covid-19 in these patients were age (aOR 1.04 IC [1.01-1.06]), ≥2 comorbidities (aOR 2.9 IC [1.1-7.8]), systemic corticosteroids (aOR 6.9 IC [2.3-20.5]) and sulfasalazine or 5-aminosalicylate (aOR 3.1 IC [1.3-7.7]). Treatment with TNF antagonists was not associated with the severity of Covid-19.

Takeaways

Age, comorbidities, and corticosteroids are associated with the severity of Covid-19 in patients with Chronic Inflammatory Bowel Disease. TNF antagonists are not.

Strenght of evidence Moderate

- Large, global database, including all ages
- Possible reporting bias (based on the willingness of physicians): reporting of the most severe cases
- Selection bias also possible in the other way: the most serious cases who died outside the hospital are not recorded.
- Possibility of unmeasured confounding factors

Objectives

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

Method

A retrospective study from an international database (SECURE-IBD) recording cases of Covid-19 in patients with inflammatory bowel disease.
Calculation of age-standardized mortality and multivariate logistic regression to identify factors associated with severe Covid-19 (defined by admission to intensive care, use of ventilation, and/or death).

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