Corticosteroids use in IBD Patients may increase COVID-19 complication

Individuals with inflammatory bowel disease (IBD) under corticosteroids are at elevated risk for severe COVID-19 complications. The findings were published in Inflammatory Bowel Diseases.

The retrospective cohort study, spanning from August 2019 to August 2021, enrolled a substantial 102,986 patients with IBD (48,728 with Crohn's disease and 47,592 with ulcerative colitis), with an average age of 53, of which 55% were female. The research delved into the utilization of various IBD medications in the 90 days preceding cohort entry, tracking patient outcomes through COVID-19 hospitalization, mechanical ventilation or inpatient death.

Preliminary findings indicate that 0.4% of the IBD patients (412 individuals) required hospitalization due to COVID-19. Notably, patients using corticosteroids exhibited a higher incidence of hospitalization (0.6% compared to 0.3% in non-users).

This trend translated to an increased likelihood of needing mechanical ventilation for corticosteroid users (1.9% compared to 0.05% in non-users), with a similar pattern observed in inpatient deaths due to COVID-19. In contrast, patients receiving anti-tumor necrosis factor α therapy showcased a lower rate of hospitalization (0.2% compared to 0.5% in non-users), suggesting a potential protective effect.

Age also emerged as a significant factor impacting COVID-19 outcomes, with older patients experiencing higher hospitalization rates. The study's aggregate data nature precluded more advanced multivariate analyses, leaving room for future research to explore these relationships in greater depth.

These findings carry important implications for clinical practice. The study underscores the higher COVID-19 risk associated with corticosteroid use in IBD patients, advocating for careful consideration of the benefits and risks of such treatment, particularly in the context of the ongoing pandemic. On the other hand, the potential protective effect of anti-tumor necrosis factor α therapy provides clinicians with valuable insights into treatment decisions for IBD patients during the pandemic.

As the medical community continually refines its understanding of COVID-19 and its interactions with various patient populations and treatments, studies like this provide a critical foundation for evidence-based decision-making. 

Reference:

Long, M. D., Parlett, L., Lewis, J. D., Haynes, K., Adimadhyam, S., Hou, L., Wolfe, A., Toh, S., Burris, J., Dorand, J., & Kappelman, M. D. (2023). Corticosteroids but not Anti-TNF Are Associated With Increased COVID-19 Complications in Patients With Inflammatory Bowel Disease. In Inflammatory Bowel Diseases. Oxford University Press (OUP). https://doi.org/10.1093/ibd/izad176