key: cord-0943052-l2m0m9f1
authors: Allocca, Mariangela; Fiorino, Gionata; Zallot, Camille; Furfaro, Federica; Gilardi, Daniela; Radice, Simona; Danese, Silvio; Peyrin-Biroulet, Laurent
title: Incidence and patterns of COVID-19 among inflammatory bowel disease patients from the Nancy and Milan cohorts
date: 2020-04-30
journal: Clin Gastroenterol Hepatol
DOI: 10.1016/j.cgh.2020.04.071
sha: 9f55593e26274f2f7130301b645ba11f616b1642
doc_id: 943052
cord_uid: l2m0m9f1

nan

The first cases of COVID-19 infection were reported in December, 2019, in Wuhan, China. Italy (in particular Lombardy) and France (in particular Northeast) have been gravely hit. Both physicians and inflammatory bowel disease (IBD) patients are deeply concerned that immunosuppressants or biologics may increase the risk of COVID-19 infection. IOIBD has put in place an international registry, SECURE-IBD, for tracking all the cases with inflammatory bowel diseases (IBD) infected by COVID-19 (SECURE-IBD Registry. http://www.covidibd.org). It will describe the outcomes of infected patients and the association between IBD-related medications and these outcomes.

Immune-mediated inflammatory disorders (IMID), including IBD, are known to be associated with changes in host defence. Hence, one could speculate that patients with IMIDs may be more susceptible to COVID-19 infection. However, reports from areas exposed to high risk of COVID-19 infection interestingly do not report cases of IBD patients with COVID-19 1 . Ongoing registries cannot address this issue due to the lack of accurate denominator data.

In a large cohort of IBD patients from France (Nancy University Hospital; 2000 patients) and Italy (Humanitas, Milan; 4000 patients), all consecutive IBD patients infected by COVID-19 were included since the beginning of the pandemic. COVID-19 cases were identified via regular tele-medicine visits and infusion center visits. Diagnosis of COVID-19 was made by routinely used PCR nasopharyngeal swab testing for all patients. The cumulative incidence was calculated. The denominator was based on prospectively maintained databases used to identify patients eligible for clinical trials at both centers.

The characteristics of these 15 COVID positive IBD patients are reported in Table 1 . Nine patients have Crohn's disease, three had an active disease and all but one were treated with biological therapy and/or immunosuppressive therapy at time of COVID-19 infection diagnosis. Four are male, all but one are under 60 years and two have comorbidities, including obesity and hypertension, that are considered as risk factors for a worse outcome of COVID-19 infection 2 . Five out of 15 patients were hospitalized, but none of them required intensive care and no death was reported.

The cumulative incidence of COVID positive IBD patients in our cohort is 0.0025, which is broadly similar to that observed in the general population (current cumulative incidence in France and Italy is 0.0017). By contrast, mortality rate (13%) and need for intensive care support (6%) are much higher in the general population than in our combined cohort (no cases).

A key feature of COVID-19-related acute respiratory distress syndrome (ARDS) is the activation of the immune system characterized by a cytokines storm 3 . IBD patients might be protected by the use of potent anti-inflammatory drugs such as anti-TNF therapy and present milder disease or be asymptomatic more frequently than in the general population. Anti-TNF therapy has been associated with a low risk of opportunistic viral infections in a large French administrative database 4 .

Interestingly, no fatality has been reported in patients undergoing transplantation treated with chemotherapy or other immunosuppressive medicaments during SARS-COV (severe acute respiratory syndrome Coronavirus) and MERS-COVID (Middle East respiratory syndrome Coronavirus) outbreaks 

Abbvie and Pfizer; GF received consultancy fees from Ferring

SD has served as a speaker, consultant and advisory board member for Schering-Plough

Applied Molecular Transport, OSE Immunotherapeutics, Enthera, Theravance ; grants from Abbvie, MSD, Takeda