key: cord-0883071-mb4sa22t authors: Rodríguez-Lago, Iago; Ramírez de la Piscina, Patricia; Elorza, Ainara; Merino, Olga; Ortiz de Zárate, Jone; Cabriada, José Luis title: Characteristics and prognosis of patients with inflammatory bowel disease during the SARS-CoV-2 pandemic in the Basque Country (Spain) date: 2020-04-21 journal: Gastroenterology DOI: 10.1053/j.gastro.2020.04.043 sha: 375f89f502b7674c9516851384e13e475eb8525a doc_id: 883071 cord_uid: mb4sa22t nan Since the first description of the new severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the infection produced by this microorganism (COVID-19) has been confirmed in 1,469,544 individuals around the world (www.healthmap.org/covid-19/). In Spain, the first case of COVID-19 was reported on the 31 th January 2020, and currently there are 146,690 confirmed cases and 14,555 deaths secondary to this infection (Ministry of Health, Consumer Affairs and Social Welfare, 7 th April 2020). In the Basque Country (Spain), 9,452 subjects have a positive test for SARS-CoV-2 (7 th April 2020). Patients with Inflammatory Bowel Disease (IBD) are of special interest during this outbreak due to the high proportion of them taking immunomodulators or biologics. There is also a possible increased risk of viral infections specially in those receiving thiopurines 1, 2 . Our aim was to describe the characteristics of IBD patients with a positive test for SARS-CoV-2, including the course of the infection in terms of medical therapy, hospital or intensive care unit (ICU) admission and death. All patients with IBD and a positive test for SARS-CoV-2 from 5 sites as for the 8 th April 2020 were included in the study. We compiled all the information in an online database using REDCap 3 electronic data capture tools including IBD characteristics and current medical therapy. Data related to the infection included date of diagnosis -considered as the first positive PCR -, history of any previous contact with SARS-CoV-2 cases, clinical manifestations, radiological and laboratory findings at diagnosis. The course of the infection was assessed by including all drugs prescribed for COVID-19, need for hospital or ICU admission or death during follow-up. The medical treatment was prescribed according to local guidelines as follows. Pneumonia severity was stratified according to CURB-65 score and oxygen saturation. Hydroxychloroquine was prescribed in mild infections starting at 400 mg bid the first day, followed by 200 mg bid until day 5. Lopinavir/ritonavir 200/50 mg bid was initially indicated in patients with moderate to severe infection and relevant comorbidities or >60 years old, however more recent data lead to its withdrawal from the guidelines. Treatment with systemic steroids and/or biologics (tocilizumab or anakinra) was started in case of worsening of respiratory symptoms or acute respiratory distress syndrome. Descriptive statistics were applied in all variables. Forty patients had a positive test for SARS-CoV-2 between 27 th February and the 8 th April 2020. The main characteristics and outcomes are summarized in Table 1 . Notably, 28% and 18% of cases were under immunomodulator of biologic monotherapy, respectively. The most frequent symptoms of COVID-19 were fever (77%) and cough (67%), with 21% reporting diarrhea. After the detection of SARS-CoV-2, most patients stopped immunomodulator (82%) or biologic (43%) maintenance therapy. No patient was admitted to the ICU. Treatment-related adverse events were reported in two patients (7.6%). Both cases experienced gastrointestinal intolerance secondary to lopinavir/ritonavir which resolved after its withdrawal. A 54 year-old woman with mild COVID-19 infection and a recent IBD diagnosis was admitted due to severe ulcerative colitis (UC) and received two doses of infliximab 10 mg/kg (week 6 and 7) during the course of the infection. She achieved clinical remission and recovered without sequelae. Two deaths were reported (5%). One in an 86-year-old male with prior diagnosis of diabetes, prostate adenocarcinoma and ulcerative proctitis on mesalamine. The second occurred in a 77-year-old male with dementia and left-sided UC under mesalamine and methotrexate. In both cases the main cause of the death was COVID-19 complicated with acute respiratory distress syndrome. Here, we observed that patients with IBD and a positive test for SARS-CoV-2 have a good overall prognosis. A relevant aspect is that around one third of patients were under immunomodulator therapy, while 18% were on biologics. Moreover, although half of them required hospital admission, none were admitted to the ICU or needed mechanical ventilation. We acknowledge that this is a quickly evolving field, with new data arising almost every day. Although our study has some important limitations, we hope that these data can bring some practical insights for thousands of colleagues and patients with IBD who are fighting against this pandemic. Risk of Serious and Opportunistic Infections Associated With Treatment of Inflammatory Bowel Diseases Relevant Infections in Inflammatory Bowel Disease, and Their Relationship With Immunosuppressive Therapy and Their Effects on Disease Mortality Research electronic data capture (REDCap)--a metadatadriven methodology and workflow process for providing translational research informatics support Are patients with inflammatory bowel disease at increased risk for Covid-19 infection? Inflammatory bowel disease care in the COVID-19 pandemic era: the Humanitas, Milan experience Uneventful course in IBD patients during SARS-CoV-2 outbreak in northern Italy Implications of COVID-19 for patients with pre-existing digestive diseases Prolonged presence of SARS-CoV-2 viral RNA in faecal samples All data are displayed as median (interquartile range) and N (%).