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Commentary
COVID-19 and IBD drugs: should we change anything at the moment?
  1. Charlie W Lees1,2,
  2. Peter M Irving3,4,
  3. Laurent Beaugerie5
  1. 1 Edinburgh IBD Unit, Western General Hospital, Edinburgh, UK
  2. 2 Centre for Genomics and Experimental Medicine, University of Edinburgh Western General Hospital, Edinburgh, UK
  3. 3 Department of Gastroenterology, Guy’s and St Thomas’ Hospital, London, UK
  4. 4 School of Immunology and Microbial Sciences, King's College London, London, UK
  5. 5 Sorbonne Université, Department of Gastroenterology, AP-HP, Hôpital Saint-Antoine, F75012, Paris, France
  1. Correspondence to Professor Charlie W Lees, Edinburgh IBD Unit, Western General Hospital, Edinburgh EH4 2XU, UK; charlie.lees{at}ed.ac.uk

https://doi.org/10.1136/gutjnl-2020-323247

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    The COVID-19 pandemic has raised questions about the management of people with inflammatory bowel disease (IBD).1 To date, there have been over 43 million confirmed cases of COVID-19 globally, including over 1.1 million deaths (https://COVID-19.who.int). What have we learnt about the risks of SARS-CoV-2 infection in patients with IBD and is there any evidence to support a change in IBD management?

    Established risk factors for poor COVID-19 outcomes are older age, male sex, obesity, non-white ethnicity, type 2 diabetes, social deprivation and a range of comorbidities (respiratory disease, cardiovascular disease, stroke, malignancy and liver disease).2 Based on prior knowledge and early observations from China and Italy, patients with IBD felt to be at higher risk included older patients with comorbidities, patients on higher doses of systemic corticosteroids and patients with active disease.1 3 However, they were generally advised not to stop IBD treatment in order to minimise the risk of flare, steroid prescription and hospitalisation during the pandemic.1

    The Surveillance Epidemiology of Coronavirus Under Research Exclusion for Inflammatory Bowel Disease (SECURE-IBD) Registry was set up to collect data on confirmed SARS-CoV-2 infections in people with IBD to address the urgent need for information guiding decisions about drug therapy during a time of great uncertainty. This physician-reported registry has accrued over 2700 cases to date (https://covidibd.org/current-data/). An initial analysis of 521 patients reported an association between corticosteroids and adverse COVID-19 outcomes.4 Ungaro and colleagues now report an expanded analysis on the first 1439 cases.5 These cases were 34.5% from the USA, 51.4% male individuals and 82.1% white. Overall, 38.5% of patients were on anti-tumour necrosis factor (TNF) therapy and 30.6% were taking a 5-amino salicylic acid (5-ASA) preparation. The primary outcome measure of severe COVID-19 disease was …

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    Footnotes

    • Twitter @charlie_lees

    • Contributors All authors contributed equally to the manuscript.

    • Funding This study was funded by UK Research and Innovation (MR/S034919/1).

    • Competing interests CWL has received research support from Abbvie and Gilead, acted as a consultant to Abbvie, Janssen, Takeda, Pfizer, MSD, Hospira, Pharmacosmos, GSK, Gilead, Topivert, Vifor Pharma, Dr Falk, Oshi Health, Trellus Health and Iterative Scopes; he has received speaking fees and travel support from Pfizer, Janssen, Abbvie, MSD, Takeda, Shire, Ferring, Hospira, Warner-Chilcott and Dr Falk. PMI has received fees for speaking on the behalf of or acting in an advisory capacity for AbbVie, Arena, Biogen, Celgene, Ferring, Prometheus, Shire, Warner Chilcott, Takeda, MSD, Vifor Pharma, Pharmacosmos, Topivert, Genentech, Hospira, Samsung Bioepis, VH2, Janssen, Sandoz, Lilly and Roche and has received financial support for research from MSD, Pfizer and Takeda. LB has received consulting fees from Janssen and Pfizer, lecture fees from Abbvie, Janssen, MSD, Ferring Pharmaceuticals, Mayoly-Spendler, Takeda and Tillots, and research support from Abbott, Ferring Pharmaceuticals, Hospira-Pfizer, Janssen, MSD, Takeda and Tillots.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Patient consent for publication Not required.

    • Provenance and peer review Commissioned; internally peer reviewed.

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