key: cord-0908225-4quhkcj5
authors: Fan, Dali; Gearry, Richard B.
title: Editorial: IBD medications during the COVID‐19 pandemic—are they safe to use?
date: 2021-06-25
journal: Aliment Pharmacol Ther
DOI: 10.1111/apt.16459
sha: 4841ec9b90016544a7df60324e54161a1d423e1d
doc_id: 908225
cord_uid: 4quhkcj5

This article is linked to Meyer et al paper. To view this article, visit https://doi.org/10.1111/apt.16410

The global pandemic caused by Coronavirus disease 2019 (COVID-19) has, to date, infected over 160 million people worldwide. Since COVID-19 was first recognised, concerns have been raised about the safety of inflammatory bowel disease (IBD) medications on COVID-19 outcomes. 1-6 Patients with IBD frequently require treatment with medications that suppress the immune system, that are associated with an increased risk of serious infections. 7, 8 Recently, a French study by Meyer et al investigated the association between commonly prescribed IBD medications and severe COVID-19 (a composite of hospitalisation, mechanical ventilation and/or death). 9 The authors identified 268 185 IBD patients in the French national health database who were followed for 6 months between February and August 2020, corresponding to the first 'wave' of COVID-19 in Europe. Consistent findings were observed in this population-based study compared to other published studies. Older patients, those with multiple comorbidities, and those taking systemic corticosteroids were at increased risk of severe COVID-19. 1- 6, 9 With regard to other IBD medications, there was no difference The reasons for these disparate findings are likely many. Firstly, the study by Meyer et al is population-based and, therefore, less likely to be prone to selection and reporting biases. On the other hand, the clinician-reported case finding in the SECURE-IBD registry could lead to over-reporting of IBD cases who see their clinician more frequently and, perhaps, those with more severe COVID-19 infections requiring medical attention. However, 73.7% of IBD patients in the French national health database were on neither anti-TNF or immunomodulators, which is consistent with a previous French study 10 but may make extrapolation to other IBD populations difficult. This

French, population-based study is also large with 189 289 IBD patients, though the primary endpoint was incident lymphoma.

The key principle emerging from this and other studies is that remission should be maintained with steroid-sparing agents. Cessation of immunomodulators or anti-TNF drugs places patients with IBD at increased risk of requiring steroids or hospitalisation for disease flare, both of which may increase the risk of contracting COVID-19 and experiencing severe, life-threatening disease.

Declaration of personal interests: Richard Gearry has served as an advisory board member for Zespri International Ltd, and has received research funding from Zespri International Ltd. 

patients with inflammatory bowel diseases: results from an international registry

Effect of IBD medications on COVID-19 outcomes: results from an international registry

Clinical outcomes of Covid-19 in patients with inflammatory bowel disease: a nationwide cohort study

Prevalence and outcomes of COVID-19 among patients with inflammatory bowel disease-a Danish prospective population-based cohort study

Risk of severe coronavirus disease 2019 in patients with inflammatory bowel disease in the United States: a multicenter research network study

Coronavirus disease 2019, immune-mediated inflammatory diseases and immunosuppressive therapies -a Danish population-based cohort study

Increased risk of pneumonia among patients with inflammatory bowel disease

Increased risk of influenza and influenza-related complications among 140,480 patients with inflammatory bowel disease

Risk of severe COVID-19 in patients treated with IBD medications: a French nationwide study

Association between use of thiopurines or tumour necrosis factor antagonists alone or in combination and risk of lymphoma in patients with inflammatory bowel disease