Anti-TNF Therapy Correlated with Better Outcomes in IBD Patients with COVID-19

Non-Sponsored Content

INFECTIOUS DISEASE

Medical writer: Connie TANG | Last updated: 20 December 2021 | In: COVID-19, Infectious Disease

Article Keywords

IBD, inflammatory bowel disease, biologics, Crohn’s disease, immunomodulators, TNF, COVID-19, ulcerative colitis, anti-TNF, SARS-CoV-2

The coronavirus disease 2019 (COVID-19) is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Crohn’s disease (CD) and ulcerative colitis (UC) are inflammatory bowel diseases (IBD) that have an increasing incidence and prevalence in different regions around the world.¹ The use of immunomodulators or biologic drugs to control overactive immune responses in the treatment of IBD has been known to increase risk of infections, potentially posing an elevated risk of inoculation with SARS-CoV-2.² A systematic review and meta-analysis investigated the evolving epidemiology, clinical characteristics, therapeutic options, and outcomes in IBD patients with COVID-19 to reveal the actual risk of infection or development of COVID-19 in IBD patients at risk or those on immunosuppressive treatment.³

The investigators searched and included studies of patients with IBD and confirmed COVID-19 from multiple databases (e.g. PubMed, EMBASE, Cochrane Central, Clinicaltrials.gov, Web of Science, MedRxiv and Google Scholar) with a focus on data regarding the prevalence, patient characteristics, pre-infection treatments for IBD, comorbidities, hospitalisation, intensive care unit (ICU) admission, and death.³

A total of 50,706 IBD patients with and without COVID-19 were included in 14 studies, with the prevalence of infection of 1.01% (95% confidence interval [CI], 0.92-1.10). Among the IBD patients with COVID-19, 52.7% had CD, 42.2% had UC, and 5.1% had indeterminate colitis.³ Nine studies (n=687) investigating the outcomes of IBD therapy reported that patients on antitumour necrosis factor (anti-TNF) therapy had a lower risk of hospitalisation (risk ratio [RR], 0.24; 95% CI: 0.16-0.35; p <0.01; I² = 0%) and ICU admission (RR, 0.10; 95% CI: 0.03-0.37; p <0.01) but not death (RR, 0.16; 95% CI: 0.02-1.71; p=0.13; I² = 39%), compared with patients on corticosteroids.³ In comparison with patients on mesalamine, patients on anti-TNF therapy had a reduced risk of hospitalisation (RR, 0.37; 95% CI: 0.25-0.54), ICU admission (RR, 0.20; 95% CI: 0.07-0.58), and death (RR, 0.21; 95% CI: 0.04-1.00).³ There was no difference in outcomes regarding hospitalisation, ICU admission and death in patients on immunomodulators vs mesalamine or anti-TNF therapy.³

In conclusion, there is a low prevalence of COVID-19 in IBD patients, and anti-TNF therapy is correlated with more favourable COVID-19 outcomes than therapy with corticosteroids or mesalamine.³

Reference

Molodecky NA et al. Gastroenterology. 2012;142(1):46-54.e42.

Rubin DT et al. Gastroenterology. 2020;159(1):6-13.e6.

Tripathi K et al. Inflammatory Bowel Diseases. 2021;(izab236).

Achieving the Best Outcomes under COVID-19 Endemicity

Inactivated and mRNA COVID-19 vaccines in patients with autoimmune rheumatic diseases – A city of two tales

Late but sinister post-COVID-19 conditions: new-onset rheumatic diseases

COVID-19 Infection and Subfertility: A Subtle and Debatable Complication

Previous Next

17 May 2023

Achieving the Best Outcomes under COVID-19 Endemicity

30 January 2023

Inactivated and mRNA COVID-19 vaccines in patients with autoimmune rheumatic diseases – A city of two tales

Disclaimer

This article is not medical advice. Patients should seek personal assessment by a licenced specialist. Physicians are recommended to read the full publication(s) as cited in the article before making medical decisions. This article does not supersede nor replace the published article(s).