A population-based study on COVID-19 among patients with inflammatory bowel diseases: Preliminary results from the danish COVID-IBD database

Introduction: Patients with immune-mediated diseases (IMDs) are postulated to be at increased risk of infection by SARS-CoV-2, a novel virus giving rise to COVID-19 which has rapidly become a global health emergency However, data on the risk profile of patients with inflammatory bowel diseases (IBD including Crohn's disease (CD) and ulcerative colitis (UC)) are scarce Aims & Methods: We aimed to conduct a prospective population-based study including all patients with co-occurring IBD and COVID-19 in Denmark The objectives were to characterize these patients, as well as their short-term outcomes in terms of hospital admissions, admissions to intensive care units, requirements of ventilators and mortality The patients were identified both manually at all IBD ambulatory centers as well as by electronical diagnosis codes Clinical remission of IBD was defined as Harvey Bradshaw Index ≤4 or Simple Clinical Colitis Activity Index ≤2, biochemical remission was defined as C-reactive protein (CRP) <5 or f-Calprotectin <200 and endoscopic remission was defined as Mayo Endoscopic score ≤1 In addition, we estimated the prevalence of COVID-19 among patients with IBD through surveys sent to members of the Danish IBD patient association (CCF) Results: Four patients with IBD were tested positive for SARS-CoV-2 in a survey answered by 2000 patients with IBD, which is equal to a prevalence of COVID-19 of 0 2% In the nationwide database, a total of 23 patients had co-occurring IBD and COVID-19 and all were enrolled in this study Most of these patients (15/23) were living in the Capital Region of Denmark CD and UC appeared equally in the cohort and the median age at diagnosis of COVID-19 was 46 (IQR 39-59) The disease localization of CD was mostly confined to the colon (6/11), while 5/12 of the patients with UC had proctitis In total, 12/23 patients were in clinical remission at COVID-19 diagnosis, while 14 patients and five patients were in biochemical and endoscopic remission, respectively Every fourth of the patients were non-smokers (6/23) and most were overweight with a median body mass index of 29 (22-30) A total of 12 patients received IMS including azathioprine (7) and biologic therapies (adalimumab: 4, infliximab: 2 and vedolizumab: 2) In addition, seven patients had undergone colectomy A large proportion of the patients had other co-occurring IMDs including asthma (3), spondyloarthropathy (1), type 1 diabetes (1), psoriasis (1) and celiac disease (1) A total of four patients required hospitalization due to COVID-19 with a median admission length of 23 days (11-35), of which two patients required admission to an intensive care unit with treatment with either non-invasive ventilator or mechanical ventilator The risk of hospital admission did not seem to be associated with the treatment with IMS as only half of the patients received these therapies Lastly, one elderly patient with co-occurring asthma among our cohort died due to COVID-19 Conclusion: From this ongoing population-based study, we report a low prevalence of 0 2% of COVID-19 among patients with IBD in Denmark Our findings are in line the current literature but might be biased due to different screening strategies over time in Denmark We notice that a high proportion of patients with COVID-19 and co-occurring IBD were obese, had a prior colectomy and required hospitalization and admission to an intensive care unit This does not seem to be associated with the IBD-related immunosuppressive therapies, and the high proportions could be due to the low sample size