COVID-19 Evidence Alerts
from McMaster PLUSTM

Current best evidence for clinical care (more info)

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Etiology Ungaro RC, Brenner EJ, Gearry RB, et al. Effect of IBD medications on COVID-19 outcomes: results from an international registry. Gut. 2021 Apr;70(4):725-732. doi: 10.1136/gutjnl-2020-322539. Epub 2020 Oct 20.

OBJECTIVE: We sought to evaluate COVID-19 clinical course in patients with IBD treated with different medication classes and combinations.

DESIGN: 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 used multivariable regression with a generalised estimating equation accounting for country as a random effect to analyse the association of different medication classes with severe COVID-19, defined as intensive care unit admission, ventilator use and/or death.

RESULTS: 1439 cases from 47 countries were included (mean age 44.1 years, 51.4% men) of whom 112 patients (7.8%) had severe COVID-19. Compared with tumour necrosis factor (TNF) antagonist monotherapy, thiopurine monotherapy (adjusted OR (aOR) 4.08, 95% CI 1.73 to 9.61) and combination therapy with TNF antagonist and thiopurine (aOR 4.01, 95% CI 1.65 to 9.78) were associated with an increased risk of severe COVID-19. Any mesalamine/sulfasalazine compared with no mesalamine/sulfasalazine use was associated with an increased risk (aOR 1.70, 95% CI 1.26 to 2.29). This risk estimate increased when using TNF antagonist monotherapy as a reference group (aOR 3.52, 95% CI 1.93 to 6.45). Interleukin-12/23 and integrin antagonists were not associated with significantly different risk than TNF antagonist monotherapy (aOR 0.98, 95% CI 0.12 to 8.06 and aOR 2.42, 95% CI 0.59 to 9.96, respectively).

CONCLUSION: Combination therapy and thiopurines may be associated with an increased risk of severe COVID-19. No significant differences were observed when comparing classes of biologicals. These findings warrant confirmation in large population-based cohorts.MKH should be changed to MDK for co-last author line.

Discipline / Specialty Area Score
Hospital Doctor/Hospitalists
Internal Medicine
Pediatrics (General)
Pediatric Hospital Medicine
Infectious Disease
Comments from MORE raters

Gastroenterology rater

It was impossible for me to derive any useful lesson from this paper. The exercise was a fishing trip in a database with no a priori hypothesis. We have no idea why these patients were, or were not, receiving the various IBD therapies. Equally importantly, we do not know why these patients were even tested for COVID-19. Regardless of trying to adjust for potential confounders, the influence of these two (and perhaps others) could not be accounted for. The fact that the results appeared to be similar to the earlier report (reference 17) is due, in part, to the inclusion of those 525 cases (36% of the total). While the investigators are considering using these data to decide whether or not to employ medications during the pandemic, they have no insight as to the consequences of such actions on the courses of the IBD.

Gastroenterology rater

This is an original research article from a international prospective registry for patients who have COVID-19 and IBD as reported by providers. While there may be reporting bias, this is a large sample with clinically relevant data regarding the safety and risk of immunosuppressive therapies. This data is for Providers [medication management] and patients [Risk counseling].

Gastroenterology rater

Knowing which medications are safe in COVID-19 is critical. This shows many medications we thought were dangerous are in fact safe and should be summarized for clinicians.

Hospital Doctor/Hospitalists rater

It's useful to remember that certain medications could represent an additional risk factor for COVID-19.

Infectious Disease rater

This may be of interest to gastroenterologists, but COVID-19 experience should have taught us by now that retrospective or observational data rarely turns out to be useful.

Internal Medicine rater

Important to investigate which type of immunosuppressants increase COVID-related harm. Since there was, understandably, no placebo group, any increased risk for serious harm related to anti-tnfs could not be discerned.

Internal Medicine rater

Useful info for all to be familiar with as we continue to face this worldwide pandemic, and try to adjust meds for patients at higher risk.

Pediatric Hospital Medicine rater

Well done review that highlights the risks of COVID while using certain immune modulators.

Pediatrics (General) rater

IBD meds may be associated with more severe Covid infection. Useful information.