Lessons from the COVID-19 pandemic for IBD management

Prof. Siew Ng (Chinese University of Hong Kong, Hong Kong) discussed the current evidence on inflammatory bowel disease (IBD) and COVID-19. The risk of COVID-19 in patients with IBD, the impact of IBD medication on COVID-19 severity, and guidance on COVID-19 vaccines in patients with IBD were the main topics.

Risk of COVID-19

“In general, patients with IBD do not have an increased risk of contracting COVID-19,” said Prof. Ng. The incidence of COVID-19 among patients with IBD is relatively low (0.3%) compared with the general population (0.2–4.0%) [1,2]. In addition, it has been shown that the use of anti-TNFs or thiopurines does not lead to an increased risk of contracting COVID-19 [3]. Regarding COVID-19 outcomes, it has been demonstrated that patients with IBD who are older, male, have comorbidities, or higher disease activity, are more likely to experience worse outcomes, such as hospitalisation, ventilation, or death [4].

IBD medication and COVID-19

“The use of corticosteroids has consistently been associated with an increased risk of worse COVID-19 disease outcomes in patients with IBD,” continued Prof Ng. “In contrast, biologic agents, immunomodulators, and mesalamines were not related to worse COVID-19 outcomes.” Therefore, IBD medications do not need to be discontinued or reduced during the current pandemic, except for corticosteroids, which should be reduced whenever possible.

Vaccines and IBD

“The current evidence suggests that COVID-19 vaccines are not associated with an increase in IBD flares or other adverse events. Also, in patients with IBD, full vaccination, but not partial vaccination, resulted in a 69% reduced hazard of SARS-CoV-2 infection compared with unvaccinated patients with IBD. Therefore, patients with IBD should be vaccinated at the earliest opportunity to do so. In addition, patients who are treated with corticosteroids, anti-TNF monotherapy or combination therapy, or tofacitinib may have a compromised vaccine response. This could result in an increased risk for breakthrough SARS-CoV-2 infections. In general, a third dose is recommended in patients with IBD, especially since the arrival of the highly contagious Omicron variant [5]. Even a fourth vaccine dose might be warranted in certain patients. However, more studies need to be conducted to establish the value of a fourth COVID vaccination in patients with IBD.”

1. Ng S, et al. Lessons from the COVID pandemic for IBD management. SCI40, ECCO 2022, 16–19 February.
2. Aziz M, et al. Inflam Bowel Dis. 2020;26(10):e132–e133.
3. Khan N, et al. Gastroenterology. 2020;159(4):1592–1594.
4. Singh S, et al. Gastroenterology. 2020;159(4):1575–1578.
5. Alexander J, et al. COVID-19 vaccine-induced antibody responses are impaired in Inflammatory Bowel Disease patients treated with infliximab, ustekinumab or tofacitinib, but not thiopurines or vedolizumab. OP21, ECCO 2022, 16–19 February.

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Posted on 12 April 20228 April 2024