PT  - JOURNAL ARTICLE
AU  - Khan, Nabeel
AU  - Mahmud, Nadim
AU  - Trivedi, Chinmay
AU  - Reinisch, Walter
AU  - Lewis, James D
TI  - Risk factors for SARS-CoV-2 infection and course of COVID-19 disease in patients with IBD in the Veterans Affair Healthcare System
AID  - 10.1136/gutjnl-2021-324356
DP  - 2021 Sep 01
TA  - Gut
PG  - 1657--1664
VI  - 70
IP  - 9
4099  - http://gut.bmj.com/content/70/9/1657.short
4100  - http://gut.bmj.com/content/70/9/1657.full
SO  - Gut2021 Sep 01; 70
AB  - Objective Our aim was to explore the risk of infection with all classes of inflammatory bowel disease (IBD) medications and the impact of these medications on the disease course in a nationwide cohort of patients with IBD.Design This was a retrospective national cohort study of patients with IBD in the Veterans Affairs Healthcare System. We categorised IBD medication use immediately prior to the COVID-19 pandemic and used survival analysis methods to study associations with SARS-CoV-2 infection, as well as a combined secondary outcome of COVID-19 hospitalisation or COVID-19-related mortality.Results The analytical cohort of 30 911 patients was primarily male (90.9%), white (78.6%) and with ulcerative colitis (58.8%). Over a median follow-up of 10.7 months, 649 patients (2.1%) were diagnosed with SARS-CoV-2 infection and 149 (0.5%) met the combined secondary outcome. In adjusted models, vedolizumab (VDZ) use was significantly associated with infection relative to mesalazine alone (HR 1.70, 95% CI 1.16 to 2.48, p=0.006). Patients on no IBD medications had increased risk of the combined secondary outcome relative to mesalazine alone (sub-HR 1.64, 95% CI 1.12 to 2.42, p=0.01), however, no other IBD medication categories were significantly associated with this outcome, relative to mesalazine alone (each p>0.05). Corticosteroid use was independently associated with both SARS-CoV-2 infection (HR 1.60, 95% CI 1.23 to 2.09, p=0.001) and the combined secondary outcome (sub-HR 1.90, 95% CI 1.14 to 3.17, p=0.01).Conclusion VDZ and corticosteroid were associated with an increased risk of SARS-CoV-2 infection. Except for corticosteroids no medications including mesalazine were associated with an increased risk of severe COVID-19.No data are available. A retrospective cohort study. Deidentified data may be available from the corresponding author on request by the journal but identified data will not be available due to HIPAA rules.