ATU-3 Risk of severe COVID-19 outcomes associated with inflammatory bowel disease medications: Reassuring insights from PREPARE-IBD

• Published in: Gut Vol. 70; no. Suppl 4; p. A23
• Main Authors: Lamb, Christopher, Sebastian, Shaji, Kent, Alexandra J, Segal, Jonathan P, Gonzalez, Haidee A, Brookes, Matthew J, Mehta, Shameer J, Subramanian, Sreedhar, Bhala, Neeraj, Hicks, Lucy C, Conley, Thomas E, Patel, Kamal V, Walker, Gareth J, Kennedy, Nicholas A
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and British Society of Gastroenterology 07.11.2021; BMJ Publishing Group LTD
• Subjects: Abstracts of distinction; Coronaviruses; Corticosteroids; COVID-19; Crohn's disease; Immunomodulation; Inflammatory bowel disease; Inflammatory bowel diseases; Morbidity; Nausea; Pandemics; Prednisolone; Ulcerative colitis; Vomiting; United Kingdom > UK
• ISSN: 0017-5749; 1468-3288
• DOI: 10.1136/gutjnl-2021-BSG.41

IntroductionThis study sought to identify patient or IBD medication-related factors associated with severe outcomes from COVID-19.MethodsPREPARE-IBD was a multi-centre observational United Kingdom (UK) cohort study including adult IBD patients (≥18 yrs) diagnosed with COVID-19 by PCR between 1/3/2020 and 31/8/2020. The primary outcome was severe COVID-19 defined as requirement for intensive care admission, invasive ventilation or death. We tested associations of severe outcomes with medications and other covariates using multiple logistic regression.Results211 patients were included from 60 UK centres. 56 of 211 patients (26.5%) met the primary outcome. Severe COVID-19 was more common in ulcerative colitis relative to Crohn’s disease patients (33.9% [37/109] vs. 18.6% [16/86], p=0.018). Shortness of breath, nausea and vomiting were more common with severe COVID-19 (p<0.001 and p=0.023 respectively). Multivariable analysis (Figure panel A) identified co-morbidities and age as associated with severe COVID-19 outcomes; odds ratio (OR [95% CI]) 1.68 (1.23-2.35) for each co-morbidity, and an OR 1.03 (1.00-1.05) with each successive year of age. Neither clinically active IBD, non-white ethnicity, nor prednisolone use were associated with increased risk (Figure panel B). On multivariable analysis, mesalazine was associated with severe COVID-19 outcomes (OR 2.03 [1.01-4.12]). Univariable analysis identified biologics and thiopurines as protective (OR 0.38 [0.15-0.87] and 0.32 [0.092-0.86] respectively). On multivariable analysis no association of severe COVID-19 outcomes with thiopurine or biologic exposure was seen.Abstract ATU-3 Frigure 1ConclusionsOur data provide reassurance for the continued evidence-based use of corticosteroids, immunomodulators and biologic therapies in IBD during the ongoing COVID-19 pandemic, and is consistent with an as yet unexplained association between mesalazine use and severe COVID-19 outcomes.