Neither inflammatory bowel disease nor immunosuppressants are associated with an increased risk for severe COVID-19. An observational dutch cohort-study

Introduction: Conflicting data have been published about inflammatory bowel disease (IBD) and immunosuppressants being risk factors for severe COVID-19. These different opinions leave patients and healthcare providers confused. Reports on longer lasting clinical experiences are lacking. Aims & Methods: A retrospective search was performed for severe COVID- 19 (defined as hospital admission and/or mortality) in the first year after the SARS-CoV-2 outbreak (February 28, 2020 - February 28, 2021), in an IBD cohort from Southeast Brabant, one of the most affected Dutch regions. Cohort characteristics including age distribution and immunotherapy were explored by value-based healthcare data. Severe COVID-19 cases were detected by using ICD-10 specific codes and further examined for IBD determinants (including immunotherapy) and COVID-19 characteristics, including intensive care admission, need for respiratory support, COVID-19 treatment and mortality. The national mortality register was consulted, ensuring detection of IBD patients that died without hospital admission. Hospitalisation and mortality rates of the IBD cohort were compared with the registries of the regional and national general population. Chi-squared test with continuity corrections was used and a p-value of <0.05 was considered statistically significant. The 95% confidence intervals for a single proportion with continuity corrections were counted for all incidences. Results: The IBD cohort consisted of 1453 patients, including children, 51% had Crohn's disease, 49% ulcerative colitis, 54% were women and 15.9% was at least 70 years old. Cross-sectional examination of prescribed medication at start of the corona outbreak showed that 251 patients (17.6%) used a biologic agent, 354 (24.8%) had an immunomodulator (thiopurine/methotrexate), and 130 (9.1%) corticosteroids. One year later these counts showed 312 (21.5%), 356 (24.5%) and 125 (8.6%) patients respectively, which changed only significantly for biologics, an increase of 3.9% (CI 15.7-19.7 and 19.4-23.7, p = 0.010). Immunotherapy (mono, double or triple therapy) was used by 580 (39.9%) of IBD patients. Twenty-six percent of patients ≥70 years old used at least one immunosuppressant. Eight cases (0.55%) had severe COVID-19: seven were hospitalized (0.48%, 95% confidence interval (CI) 0.21-1.04), two died (0.14%), including one patient without hospitalisation. Six patients (75%) had comorbidity, two (25%) used mesalamine, one (12.5%) had budesonide, one (12.5%) used immunotherapy, four (50%) had no medication. Both deceased patients were older than 80 years, had severe comorbidity, but used no immunotherapy. Neither IBD nor medication seemed to play a role in COVID-19 course. Only one of 347 thiopurine-users (0.29%) was admitted, but recovered eventually. Thus, severe COVID-19 was only found in one of 580 patients (0.17%) using immunotherapy. Hospitalisation occurred significantly more in the IBD cohort than regionally (0.18%, CI 0.17-0.19 (p=0.015), but not significantly more than nationally (0.28%, CI 0.279-0.284). Mortality was equal in the IBD cohort compared with regionally and nationally. Conclusion: Neither inflammatory bowel disease nor the use of immunosuppressants are associated with an increased risk for severe COVID-19 in a cohort study with a follow up of one year.