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Risk and outcomes of coronavirus disease in patients with inflammatory bowel disease: A systematic review and meta‐analysis

United European gastroenterology journal, 2021-03, Vol.9 (2), p.159-176 [Peer Reviewed Journal]

2020 The Authors. United European Gastroenterology Journal published by Wiley Periodicals LLC. on behalf of United European Gastroenterology. ;ISSN: 2050-6406 ;EISSN: 2050-6414 ;DOI: 10.1177/2050640620972602 ;PMID: 33210980

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  • Title:
    Risk and outcomes of coronavirus disease in patients with inflammatory bowel disease: A systematic review and meta‐analysis
  • Author: Singh, Anupam Kumar ; Jena, Anuraag ; Kumar‐M, Praveen ; Sharma, Vishal ; Sebastian, Shaji
  • Subjects: coronavirus ; Covid ; COVID-19 - complications ; COVID-19 - epidemiology ; COVID-19 - mortality ; COVID-19 - therapy ; Crohn's disease ; Hospitalization ; Humans ; Incidence ; Inflammatory Bowel Diseases - complications ; Inflammatory Bowel Diseases - epidemiology ; Original ; Risk Factors ; SARS‐CoV‐2 ; Treatment Outcome ; ulcerative colitis
  • Is Part Of: United European gastroenterology journal, 2021-03, Vol.9 (2), p.159-176
  • Description: Background The risk of severe acute respiratory syndrome‐related coronavirus 2 (SARS‐CoV‐2) infection and clinical outcomes of coronavirus disease (COVID‐19) in inflammatory bowel disease are unclear. Methods We searched PubMed and Embase with the keywords: inflammatory bowel disease, Crohn's disease, ulcerative colitis and COVID‐19, novel coronavirus and SARS‐CoV‐2. We included studies reporting the frequency of COVID‐19 infection and outcomes (hospitalisation, need for intensive care unit care and mortality) in patients with inflammatory bowel disease. We estimated the pooled incidence of COVID‐19 in inflammatory bowel disease and comparative risk vis‐a‐vis the general population. We also estimated the pooled frequency of outcomes and compared them in patients who received and did not receive drugs for inflammatory bowel disease. Results Twenty‐four studies were included. The pooled incidence rate of COVID‐19 per 1000 patients of inflammatory bowel disease and the general population were 4.02 (95% confidence interval [CI, 1.44–11.17]) and 6.59 [3.25–13.35], respectively, with no increase in relative risk (0.47, 0.18–1.26) in inflammatory bowel disease. The relative risk of the acquisition of COVID‐19 was not different between ulcerative colitis and Crohn's disease (1.03, 0.62–1.71). The pooled proportion of COVID‐19‐positive inflammatory bowel disease patients requiring hospitalisation and intensive care unit care was 27.29% and 5.33% while pooled mortality was 4.27%. The risk of adverse outcomes was higher in ulcerative colitis compared to Crohn's disease. The relative risks of hospitalisation, intensive care unit admission and mortality were lower for patients on biological agents (0.34, 0.19–0.61; 0.49, 0.33–0.72 and 0.22, 0.13–0.38, respectively) but higher with steroids (1.99, 1.64–2.40; 3.41, 2.28–5.11 and 2.70, 1.61–4.55) or 5‐aminosalicylate (1.59, 1.39–1.82; 2.38, 1.26–4.48 and 2.62, 1.67–4.11) use. Conclusion SARS‐CoV‐2 infection risk in patients with inflammatory bowel disease is comparable to the general population. Outcomes of COVID‐19‐positive inflammatory bowel disease patients are worse in ulcerative colitis, those on steroids or 5‐aminosalicylates but outcomes are better with biological agents. Key Summary Current knowledge Inflammatory bowel disease may be associated with an increased risk of various infections. Certain inflammatory bowel disease therapies may predispose to an increased risk of infections (e.g., anti tumour necrosis factor and tuberculosis, tofacitinib and herpes zoster). The effect of inflammatory bowel disease and inflammatory bowel disease therapies on coronavirus disease infection and outcomes is unclear. What are the new findings? In this meta‐analysis, we found that the risk of coronavirus disease in patients with inflammatory bowel disease is similar to the general population. The risk of coronavirus disease does not seem to be affected by the underlying type of inflammatory bowel disease, that is, Crohn's disease or ulcerative colitis. The risk of adverse outcomes in inflammatory bowel disease is more in patients receiving steroids and 5‐aminosalicylates. Biological agent use seems to be protective against adverse outcomes of coronavirus disease in inflammatory bowel disease patients.
  • Publisher: England: John Wiley and Sons Inc
  • Language: English
  • Identifier: ISSN: 2050-6406
    EISSN: 2050-6414
    DOI: 10.1177/2050640620972602
    PMID: 33210980
  • Source: Journals@Ovid Open Access Journal Collection Rolling
    MEDLINE
    PubMed Central
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