key: cord-0893121-w9482jm9
authors: Lukin, Dana; Funez-dePagnier, Gabriela; Lima, Svetlana; Lai, Daniel; Duenas-Bianchi, Lucia; Ahmed, Waseem; Jacob, Vinita; Battat, Robert; Scherl, Ellen; Longman, Randy S.
title: No durable impact of COVID-19 on intestinal disease activity in subjects with IBD
date: 2021-06-05
journal: Clin Gastroenterol Hepatol
DOI: 10.1016/j.cgh.2021.06.008
sha: 3ed0a384a95b70f6a4dceac53cd5a6f452e56fe7
doc_id: 893121
cord_uid: w9482jm9

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No durable impact of COVID-19 on intestinal disease activity in subjects with IBD 3 4 5 6

Dana Lukin 1, 2, 3 , Gabriela Funez-dePagnier 1, 2, 3 , Svetlana Lima 3, 4 , Daniel Lai 1, 2, 3 , Lucia 7

Duenas-Bianchi 1, 2, 3 , Waseem Ahmed 1, 2, 3 , Vinita Jacob 1, 2, 3 , Robert Battat 1, 2, 3 , Ellen 8

Scherl 1, 2, 3 , Randy S. Longman 1, 2, 3, 4 9 10 11

1. Author The authors declare no relevant conflict of interest for this work. (Table S1) , there were no significant changes in IBD clinical disease activity, 51 endoscopic evaluation, or laboratory markers up to 7 months post-COVID-19 compared 52

to the most recent evaluation up to 6 months prior to infection ( Table 1) . Active disease 53 was present in 60% of the cohort prior to COVID-19 and 55% and 59% during and post-54 COVID-19, respectively. 55 10 patients in our cohort reported a delay in medical therapy and 8 discontinued IBD 57 medications during COVID-19; however, this subset as well as the 43 participants 58

reporting GI symptoms during COVID-19 had no significant change in disease activity 59 (Table 1) . There were no differences in the need for corticosteroids, a change in 60 medical therapy, or IBD-related surgery or hospitalization during or post-COVID-19 61 compared to the prior 6 months. COVID-19 in patients with IBD, there was initial concern that infection may lead to 81 durable negative effects on IBD activity. This concern was further compounded by the 82 need to delay or discontinue immunosuppressive therapy in IBD patients with active 83 COVID-19 5 . Reassuringly, our data reveal no significant impact on disease activity 84 during 6 months follow up post-COVID-19. Although subjects profiled in this study were 85 primarily managed as outpatients, the majority suffered from respiratory symptoms and 86 about one-third with new onset GI symptoms 1, 2 . Given the limited number of subjects 87 in this study with severe COVID-19, it will be important to follow additional cases of 88 severe COVID-19 in patients with IBD and to assess the impact of long-haul symptoms. 89

Encouragingly, these results revealed no significant need for IBD-related surgery or 90 hospitalization. 91 92 Initial reports suggesting distinct changes in the microbiome of patients with severe 93 COVID-19 raised the possibility that patients with IBD may be at higher risk for 94 microbiome alterations, which could subsequently impact disease activity 3 . While our 95 data reveal microbiome differences based on disease activity, we did not detect distinct 96 changes in participants before and after COVID-19. While validation in additional 97 cohorts will be required, our microbiome analysis reflects the first longitudinal analysis 98 of the fecal microbiome before and after COVID-19. Moreover, these findings are 99 consistent with more recent reports suggesting that microbiome changes seen in 100

Pre COVID -180 to -1 days J o u r n a l P r e -p r o o f What you need to know:

Background: Although patients with inflammatory bowel disease reported an increased frequency of gastrointestinal symptoms following infection, the durable impact of COVID-19 on IBD activity and the microbiome is not well defined.

Longitudinal follow-up data over 6 months revealed no durable impact of COVID-19 on clinical IBD disease activity or microbiome composition. Implication for patient care: While validation in additional cohorts is required, these data reassuringly suggest no long-term impact of COVID-19 on IBD disease activity and support guidelines for continued IBD maintenance care during the pandemic.

Therapy Stratify Risk of COVID-19 in Patients With Inflammatory Bowel Disease

Are Associated With Adverse COVID-19 Outcomes in Patients With 114 Inflammatory Bowel Diseases: Results From an International Registry

Alterations in Gut Microbiota of Patients With 117 COVID-19 During Time of Hospitalization

The treatment-naive microbiome in 120 new-onset Crohn's disease

AGA Clinical Practice Update on 122 Management of Inflammatory Bowel Disease During the COVID-19 Pandemic: 123 Expert Commentary

SARS-CoV-2-specific IgA and limited 125 inflammatory cytokines are present in the stool of select patients with acute 126 COVID-19