COVID-19 Infections Not More Prevalent in IBD Patients

Susanna Esposito, MD

A new analysis of available studies shows patients with inflammatory bowel disease (IBD) are not at an increased risk of COVID-19 infections or negative outcomes.

A team, led by Susanna Esposito, Pediatric Clinic, Department of Medicine and Surgery, University of Parma, identified the impact of SARS-CoV-2 infections and the immunogenicity of COVID-19 vaccines in patients with IBD.

The Theory

Past research has shown that there are certain individuals are genetically susceptible to IBD due to a dysregulated intestinal immune response to various environmental factors. It is also known that patients with IBD are at an increased risk of infections, which was particularly troublesome during the COVID-19 pandemic.

In addition, this risk if increased significantly by some of the treatments commonly used for IBD, including immunosuppressants for the most severe cases of IBD.

“IBD patients can be considered subjects with an aberrant immune response that makes them at increased risk of infections, particularly those due to opportunistic pathogens,” the authors wrote. “In many cases this risk is significantly increased by the therapy they receive.”

Analyzing Data

In the study, the investigators used available data from studies addressing COVID-19 disease or COVID-19 vaccine administration in patients with IBD, both for adult and pediatric patients.

“It is debated whether SARS-CoV-2 infection and vaccines evoke in these subjects an immune response similar to that observed in healthy people so assuring a similar protection for further infections,” the authors wrote. “Furthermore, it is unclear whether COVID-19 is more severe in IBD patients and whether it worsens the IBD course.”

The major takeaway message from the analysis is that patients with IBD are not at a higher risk of COVID-19 infections. For example, a study based in Spain showed a lower risk of infection in patients with IBD compared to the general population (4.9 case per 1,000 vs 6.2 cases per 1,000; OR, 0.74; 95% CI, 0.70-0.77; P <0.001, respectively).

There were other studies based in France, the US, Italy, China, and South Korea showing similar findings comparing the rate of COVID-19 infections in patients with IBD with the general population.

The investigators then looked at the adverse outcome rate of patients with IBD who do test positive for COVID-19. Using an IBD database, there is evidence that age and sex-standardized mortality ratios is 50% higher in patients with IBD and COVID-19 than it is in the general population of patients with COVID-19.

There is also evidence that a large portion of patients with COVID-19 develop gastrointestinal symptoms, which led to the supposition that patients with IBD were at a higher risk of infections.

In addition, if a patient is infected, the majority of cases do not require the modification of therapy because it does not negatively affect the course of COVID-19.

On the other hand, the investigators recommended discontinuing or reducing corticosteroid use because of the risk of severe forms.

Another finding is COVID-19 might modify the disease course of IDB through the impact on intestinal disease of the psychological factors deriving from the measures implemented to combat the virus.

In addition data on the immune response induced by SARS-CoV-2 or COVID-19 vaccines are less definitiveand potentially not substantially different from what is seen in healthy subjects, with the possible exception being patients with IBD treated with anti-tumor necrosis factor (anti-TNF) treatments alone or in combination with other immunosuppressants. These patients did show a reduced immune response, which might not necessarily reduce immune protection.

Another aspect not yet known is the impact of different variants on the disease course of IBD.

The study, “Risks of SARS-CoV-2 Infection and Immune Response to COVID-19 Vaccines in Patients With Inflammatory Bowel Disease: Current Evidence,” was published online in Frontiers in Immunology.