PT  - JOURNAL ARTICLE
AU  - Ryan C Ungaro
AU  - Erica J Brenner
AU  - Richard B Gearry
AU  - Gilaad G Kaplan
AU  - Michele Kissous-Hunt
AU  - James D Lewis
AU  - Siew C Ng
AU  - Jean-Francois Rahier
AU  - Walter Reinisch
AU  - Flávio Steinwurz
AU  - Fox E Underwood
AU  - Xian Zhang
AU  - Jean-Frederic Colombel
AU  - Michael D Kappelman
TI  - Effect of IBD medications on COVID-19 outcomes: results from an international registry
AID  - 10.1136/gutjnl-2020-322539
DP  - 2021 Apr 01
TA  - Gut
PG  - 725--732
VI  - 70
IP  - 4
4099  - http://gut.bmj.com/content/70/4/725.short
4100  - http://gut.bmj.com/content/70/4/725.full
SO  - Gut2021 Apr 01; 70
AB  - 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 lineData are available on reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information. All raw data are available at the SECURE-IBD website at covidibd.org.