Managing Patients With IBD in the Pandemic Era

Patients with inflammatory bowel disease (IBD) do not appear to be at increased risk of contracting COVID-19, but may be more likely to suffer adverse events under certain conditions, Jessica R. Allegretti, MD, said at the at the Advances in Inflammatory Bowel Diseases 2021 virtual meeting on Saturday, March 6, 2021.

Dr Allegretti is associate director of the Crohn's and Colitis Center and director of the Fecal Microbiota Transplant program at Brigham and Women's Hospital in Boston, Massachusetts. 

Patients with IBD who develop severe COVID-19 symptoms are primarily those who are elderly, have comorbidities, and use steroids to control their IBD, she explained.

Data from the SECURE-IBD database—an international registry of patients with IBD and confirmed COVID-19 infection—suggest that the use of thiopurines in combination therapy with anti-tumor necrosis factor (TNF) agents may increase risks, as well. However,  anti-TNF monotherapy and other biologics appear to be safe and may even offer a slight protective effect against COVID-19, and patients being treated with these therapies should continue their medication regimens.

Dr Allegretti explained the importance of managing patients with IBD who develop COVID-19 on a case-by-case basis, and how these data offer more reasons to potentially alter treatment, de-escalate combination therapy, and taper steroids. In patients with difficult-to-control IBD, she suggested that gastroenterologists consider not delaying or stopping biologics in patients with asymptomatic or mild COVID-19.

Looking at 60 studies that comprised 4243 COVID-19 patients from 6 countries, Dr Allegretti commented, “really, the main symptoms we see in these patients are gastrointestinal (GI) symptoms, anorexia, diarrhea, nausea/vomiting, and abdominal pain.” She further noted that severe disease was more common in patients who had GI symptoms than those who did not (17.1% vs 11.8%), and it was rare for patients to have GI symptoms without other COVID-19 manifestations.

“We now know a time-based strategy makes more sense,” Dr Allegretti said. Many of our patients will continue to test positive long after that 10 to 14-day window. So, for example, at my infusion unit, patients are allowed back in after a positive test; no additional days of quarantine are required beyond the 10 to 14 days.”

Dr Allegretti also pointed out that data from the National VA Database Study revealed relatively low incidence of COVID-19 in patients with IBD (.3%) when compared to the general population (.2% - 4%).

A prospective observational cohort in Italy enrolled 79 patients with established IBD and confirmed COVID-19 across 24 IBD centers; of these patients, 28% were hospitalized and 8% died. Again, risk factors included older age and increased comorbidities—the same as general population.  Dr Allegretti’s research found that patients with active IBD are also a risk for COVID-19-related severity.

“So, while this data suggested that patients with IBD who do ultimately get COVID-19 may have a more severe course, really, when we look at propensity matching, this risk is really not much, if at all. So again, I do think the data overall has been very reassuring, and not alarming,” Dr Allegretti said.

-Angelique Platas

Reference:

Allegretti J. Common covid conversations and treatment decisions. Presented at: Advances in Inflammatory Bowel Diseases virtual regional meeting. March 6, 2021