IMPROVING THE UPTAKE OF ELECTRONIC PATIENT REPORTED OUTCOME MEASURES IN A SPECIALISED AXIAL SPONDYLOARTHROPATHY CLINIC

BackgroundSheffield Teaching Hospitals (STH), UK, has a specialised axial spondyloarthropathy (axSpa) clinic run by a rheumatology consultant and physiotherapist with special interest in this area. BASDAI and BASFI patient reported outcome measures are used to assess disease activity and response to treatment, in line with national guidelines. STH has invested in MyPathway (MP), an electronic patient messaging system used for patient information, appointments and electronic patient reported outcome measures (ePROMs). The data can also be viewed at a system level on a clinician dashboard. Prior to 2020 the uptake of ePROMs was low in the axSpa clinic. The move primarily to telephone consultations in March 2020, due to the COVID-19 pandemic, created an opportunity for increasing the use of MP for ePROMs collection to enable improved remote monitoring of patients with axSpa.ObjectivesThis quality improvement project aimed to increase the use of electronic BASDAI and BASFI (ePROMs) in the axSpa clinic.MethodsA multi-pronged approach has been taken since March 2020 to increase ePROMs completion and improve their use. Each appointment was used as an opportunity to discuss and recruit patients to MP. Clinicians invited each patient to join MP and sent them a link after their appointment. QR codes were then added to all rheumatology patient letters encouraging patients to register. A pathway was set up that automatically sent a prompt to patients registered on MP to complete their BASDAI and BASFI questionnaires prior to clinic appointments. Clinicians began logging into MP to view scores during appointments to provide patients with real-time feedback.A mixed methods approach was used to assess the uptake of ePROMs over time. We tracked MP registration rates and BASDAI completion rates as the key outcome measures, using a run chart to assess special cause variation. We undertook a patient focus group to explore attitudes towards ePROMs, key barriers and opportunities for further improvement.ResultsThe total number of axSpa patients seen in the specialised clinic (named LADAS) who have registered with MP has increased from 56 (35.9%) in January 2019 to 200 (58.9%) in September 2022. There has been an improvement in the BASDAI completion rate, with 80% of patients completing more than one BASDAI in 2022, compared to 24% in 2019, as illustrated on a run chart (Figure 1). Patients can complete BASDAI forms sent to them in a previous month, therefore the completion rate some months exceeds 100%.In a dedicated focus group, patients reported that ePROMs were generally more convenient, and provided a useful record to refer back to. This could be further improved by development of a graph function to view scores over-time and the ability for patients to complete a questionnaire between appointments when they feel their disease is more active. A key theme for improving the use of ePROMs was the need for more discussion about their utility and around individual patient's scores. There is concern that the BASDAI and BASFI scores are arbitrary and lack nuance, and that the importance of these scores at an individual patient level is not clear. This may be rectified by more discussion with clinicians in appointments, to add meaning to these scores. There was also concern that sleep and other generic health measures are not covered in the BASDAI or BASFI. The EQ-5D, a generic questionnaire, is also sent to axSpa patients, but there seems to be a lack of patient awareness regarding it. There is an appetite to improve and standardise the amount of patient information accessible on MP, for example disease information and links to patient support groups.ConclusionThere has been a clear improvement in the completion of ePROMs in the dedicated axSpa clinic at STH, over the last three years. Patient feedback has highlighted key areas for further improvement to maximise the potential of ePROMs, including more discussion around PROM scores to increase understanding and add individual patient meaning and nuance.Figure 1.AcknowledgementsI have no acknowledgements to declare.Disclosure of InterestsJudith Jade: None declared, Zoe Cox: None declared, Emily Fox: None declared, Rachel Tattersall Speakers bureau: honoraria as speaker for Abbvie, Lisa Dunkley Speakers bureau: honoraria as speaker/ teaching for UCB/ Abbvie/ Pfizer.

Adopting a Telemedicine Model of Asthma Care during the Covid-19 Pandemic

Purpose of study The IMPACT DC Asthma Clinic is an intervention program designed to transition children who are heavily dependent on the emergency department for episodic care to more effective longitudinal asthma care in their primary medical homes. We sought to study the implementation of a telemedicine model for IMPACT DC during the COVID-19 pandemic in order to address barriers to care. Methods used A telemedicine model of IMPACT DC was implemented using rapid-cycle improvements and process mapping. Measures for adoption of services including visit completion, show rates, primary language, and patient satisfaction were collected for six months. Healthcare utilization data for the six months prior to the IMPACT DC clinical intervention was collected. This data was compared to in- person clinic visits over the same six-month period the previous year. Summary of results 360 patients successfully completed a telemedicine visit between April 2020 and September 2020 with an average visit show rate of 52%. Primary language was English in 89%. These patients were most frequently classified as having mild-persistent asthma and were assessed as well-controlled. Satisfaction survey response rate was 33%;overall average satisfaction was high. In the comparison group, 701 patients successfully completed an in-person clinic visit between April 2019 and September 2019 with a visit show rate of 39%. Primary language was English in 84%. These patients were most frequently classified as having mild-persistent asthma, not well-controlled. Healthcare utilization data for both groups six months prior to their visit are displayed Conclusions The use of telemedicine provides IMPACT DC a feasible and adoptable model to continue caring for children with asthma, with overall high patient satisfaction. This model addresses access barriers during the pandemic, and promises to be an adjunctive tool for reaching families with low show rates and high healthcare utilization. (Table Presented).

Application of A Facebook Platform to Engage Rural Populations in Health Awareness and Research on Heart, Lung, Blood and Sleep Disorders: The Risk Underlying Rural Areas Longitudinal Cohort Study

Background: Data is sparse regarding the utility of social media in engaging southern, rural communities in health awareness education and research. Community Advisory Board (CAB) members of the Mississippi (MS) Core of the Risk Underling Rural Areas Longitudinal (RURAL) Study suggested the use of a Facebook social media platform to promote the RURAL Study while providing live health education presentations that they could review and refer to others. Objective(s): Identify social media strategies using existing Facebook metrics to engage the populations of two rural counties in research on Heart, Lung, Blood and Sleep disorders. Method(s): The Principal Investigator of RURAL Study's MS Core collaborated with the University's Social Media Coordinator to implement a Facebook page for the Study. The team implemented six health awareness education programs focused on monthly health observances that best fit with HLBS disorders and COVID-19 concerns noted by the CABs. Facebook metrics including Reach (Organic and Paid Ads), Views, Likes, Comments and Shares were collected continuously. Finding(s): There were six Health Awareness events between February and June 2021 (Table 1). Paid Ads resulted in a greater reach among those in targeted rural communities. The number of views positively correlated with the number reached. The highest number of views were for short talks on Men's Health (June events) compared to hour-long panel discussions (Feb, May and Aug events). The numbers of Likes, Comments and Shares were similar among the different approaches. Clicks were greater among Paid Ads compared to Organic Ads. Between February and August the number of followers increased from 39 to 300 with the largest increase in July after the Men Health talks. Conclusion(s): Using social media may be an effective tool for reaching communities with health awareness and health education. Our findings support that Paid Ads (Boosts) focusing on targeted audiences are more effective than Organic Ads. Short talks are more effective than hour long programs.

Unusual Stroke: Left Ventricular Non-Compaction Causing an Embolic Cerebrovascular Accident

Background Left Ventricular Non-Compaction Cardiomyopathy (LVNC) is a rare genetic, developmental disorder when the left apical chamber of the heart contains bundles or pieces of muscle that extend into the chamber called trabeculations. These trabeculations are a sponge-like network of muscle fibers that typically become compacted to transform heart muscle to become smooth and solid during a normal development process. Those who have LVNC most commonly are asymptomatic. Those who are symptomatic present with syncope, palpitations, dizziness, dyspnea, fatigue and/or unexplained weight gain or swelling. LVNC has also been suggested as a rare cause of embolic stroke, in our patient's case, "due to sluggish blood flow in deep intertrabecular recesses." Case We present a 29 year old African American female, G2P0011, with a history of cleft palate repair, and recent pregnancy complicated by COVID-19 who reported to ED after having a fall the day before, leg weakness and numbness, unable to walk, headache and a left facial droop on day of admission. No family history of SCD or other cardiac disease was noted. On assessment, was found to have NIHSS of 7 with rate lateral gaze palsy, left facial palsy, and decreased strength and sensation of LUE and LLE. TPA was not given due to being outside the therapeutic window. CT head and MRI brain were consistent with acute right MCA stroke. Secondary stroke workup with TTE revealed reduced LVEF 15-20%, loosely arranged myocardium with suspected LVNC and RV apical thrombus. Cardiac MRI showed increased trabeculations consistent with LVNC. Decision-making Currently, there are no ACC/AHA guidelines on anticoagulation in the setting of LVNC. Cardiology and Neurology had an extensive multidisciplinary discussion on the need for anticoagulation specifically with Warfarin. The patient was educated extensively on the need for medical adherence with anticoagulation and guideline directed medical therapy. Conclusion The patient was started on guideline directed medical therapy for cardiomyopathy and was started on Warfarin after bridging from Lovenox. She continued with physical therapy and was noted to have improvement in residual deficits at her outpatient follow up.Copyright © 2023 American College of Cardiology Foundation

Stressful experiences impact clinical symptoms in people with endometriosis

Endometriosis is a chronic condition that affects ~10% of women globally. Its symptoms include chronic pelvic pain, heavy periods and tiredness/fatigue, which have been associated with poorer quality of life and mental health. We aim to explore the impact of the COVID-19 pandemic on pain and fatigue symptoms and their interactions with the impact on mental health in people with endometriosis. This global cross-sectional online survey study collected data from 4717 adults with self-reported surgical/radiological diagnosis of endometriosis between May and June 2020. The survey included questions on the current status and changes of endometriosis symptoms (pelvic pain, tiredness/fatigue, and bleeding patterns), mental health, pain catastrophising, and the impact of the COVID-19 pandemic on the respondents’ lives. Compared to 6 months earlier, Respondents reported a marked worsening of their endometriosis symptoms (endometriosis-associated pain (39.3%;95% CI: 37.7, 40.5), tiredness/fatigue (49.9%;95% CI: 48.4, 51.2) and bleeding patterns (39.6%;95% CI: 38.2, 41)) and mental health (38.6%;95% CI: 37.2, 39.9). Those with a pre-existing mental health diagnosis (38.8%) were more likely to report their symptoms worsening. Worsening of pain and tiredness/fatigue was significantly correlated with worsening of mental health (P < 0.001). The relationship between changes in mental health and (a) change in pain and (b) change in fatigue was found to be weakly mediated by pain catastrophising scores (pain: B = 0.071, lower limit of confidence interval (LLCI) = 0.060, upper limit of confidence interval (ULCI) = 0.082, tiredness/fatigue: B = 0.050, LLCI = 0.040, ULCI = 0.060). This study demonstrates that stressful experiences impact the physical and mental health of people with endometriosis. The findings highlight the need to consider psychological approaches in the holistic management of people with endometriosis.Lay summary: Endometriosis is a chronic condition in which tissue similar to that of the lining of the womb grows outside it. It affects around 10% of women globally, and the symptoms often include persistent pelvic pain, heavy periods and tiredness/fatigue. These symptoms are associated with impaired mental health and life quality. This study used an online questionnaire to assess the experiences of people with endometriosis during the first months of the pandemic. Results from 4717 adults revealed that pelvic pain, tiredness/fatigue and bleeding worsened in more than 39% of the participants. Poor mental health was also exacerbated and associated with worsening in tiredness/fatigue. Further analysis revealed that this relationship could be partially explained by ‘pain catastrophising’, which measures how participants think about their pain. Our results suggest that stressful experiences like the pandemic negatively impact the already burdened mental health of people with endometriosis, who could benefit from psychological interventions.

US shortages of agents used to treat poisonings over the last 10 years (2012-2021)

Background: Drug shortages represent a longstanding challenge for healthcare providers, including toxicologists, who continue to confront scarcities of antidotes and other agents used to treat poisonings. Prior research examining availability of drugs with toxicologic applications from 2001 to 2013 demonstrated broad shortages including anticholinergic, cholinergic, and cyanide antidotes, anti-hypoglycemics, chelators, antivenom, naloxone, sedative- hypnotics, and decontamination products, many of which were unresolved and involved xenobiotics without therapeutic alternative. Reports of vital agents being scarce or unobtainable have continued since 2013, and new pressures on global and US (United States) supply chains have emerged, most notably the COVID-19 pandemic. Given this, up-to-date analysis of shortages of agents used to treat poisonings is needed. Method(s): US drug shortage data from January 2012 to December 2021 were obtained from the University of Utah Drug Information Service. Shortage data for agents used to treat poisonings were analyzed. Information on drug type, formulation, shortage reason, shortage duration, number of manufacturing sources, substitute availability, and substitute agent shortage during the study period were investigated. Result(s): 1570 drug shortages were reported during the study period;230 (14.6%) involved agents used to treat poisonings. Of the 230 shortages, 21.3% were unresolved as of December 2021. Mean shortage duration was 13.6 months. The longest shortage involved intravenous calcium gluconate and lasted 78 months. Intravenous dextrose products were the agent most frequently affected by shortage, with 20 shortages in total. 58 agents had multiple shortages. Total shortages peaked in 2017 with 33 shortages reported. 20 shortages were reported in 2020 and 24 in 2021 during the COVID-19 pandemic. 10.9% of shortages involved single-source products;however, this number is limited by incomplete reporting. 80.9% of shortages involved parenteral products. Agent classes with the most shortages reported were: Sedative-hypnotics (12.2% of shortages), anti-hypoglycemics (9.6%), anticoagulant reversal (7.8%), vitamins/electrolytes (7.4%), blood pressure support (7%), antihypertensives (6.5%), antimuscarinic delirium (4.8%), and chelators (4.3%). Three naloxone shortages were reported, one of which is ongoing due to increased demand. Buprenorphine and methadone shortages were reported but are resolved as of December 2021. New shortages of multiple pressors and flumazenil were reported. The most common reason for shortage was a manufacturing issue, occurring in 36.1% of shortages. Shortage reason was not reported 37.8% of the time. For 77% of shortages an alternative therapeutic agent was available, however 97% of alternatives were also affected by shortage at some point during the study period. Conclusion(s): Shortages of agents used to treat poisonings remain problematic. For the time period 2011-2021 previously reported shortages of many products persist and new shortages have emerged. The ongoing naloxone shortage is particularly concerning given the continued rise in drug overdose deaths in the US in 2021, as are shortages of buprenorphine and methadone used to treat opioid use disorder. Despite supply chain stressors, total shortages did not peak during the COVID-19 pandemic.

Practic-ing culture: exploring the implications of pre-existing mobility cultures on (post-) pandemic practices in Norway, Ireland, and the United States

Issues of culture have to date been underexplored in practice-theoretical approaches to consumption. As a disruptive force affecting citizen mobility all over the world, the COVID-19 pandemic provides a unique empirical context to explore how culture and practice intersect, specifically concerning how unsettling events affect practices across different cultural and governing settings. Applying a combined mobility-culture and practice-theoretical framework, we conceptualize mobility cultures as setting-specific arrangements of practices that shape and reflect distinct, temporally unfolding, socio-material contexts. Comparing three cities with different mobility cultures in Norway, Ireland, and the United States, we combine 63 qualitative interviews with a contextual analysis of mobility settings to explore how daily urban mobilities have been transformed. We find that existing variation in mobility cultures, including bundles of place-specific mobility-related norms and infrastructures, mediate the impact of disruption, shaping how changes in modes, meanings, and performances of mobilities transpire. Notably, the analysis reveals how underlying cultures of mobility shape how practice trajectories respond and are reconfigured in a pandemic health-risk society. The article concludes by discussing the implications of the findings for understanding how culture and practice intersect and calls for further comparative culture-focused analysis in social science research on consumption. We consider how cross-cultural analysis can inform science and policy efforts focused on transitions toward low-carbon mobilities. © 2022 The Author(s). Published by Informa UK Limited trading as Taylor & Francis Group on behalf of the Environmental Policy Group, Wageningen University & Research.

Making sense of a mess: “doing” resilience in the vortex of a crisis

Purpose: The purpose of the paper is to investigate how human resource professionals (HRPs), in a variety of organizations, responded to the crisis brought about by the event of COVID-19. In particular, it aims to show how organizations, across all sectors, in Western Australia responded with urgency and flexibility to the crisis and showed “resilience in practice”. Design/methodology/approach: The study is based on 136 questionnaire responses, 32 interviews and 25 managerial narratives. The mixed qualitative methodology was designed to enable an investigation of the impact of COVID-19 and the response of HRPs. Findings: HRPs have responded with agility and flexibility to the impact of COVID-19. They have done so through extensive trial and error, sometimes succeeding, sometimes failing. They have not simply activated a preconceived continuity plan. Research limitations/implications: The research indicates that resilience is an ongoing accomplishment of organizations and the people in them. The objective was description rather than prescription, and the research does not offer solutions to future pandemic-like situations. Practical implications: The research suggests that, given the impact of COVID-19 on organizations, HR practices, processes and policies will need to be thoroughly reconsidered for relevance in the post-COVID world. Possible future directions are highlighted. Originality/value: The research considers the actions of HRPs as they responded to a global crisis as the crisis unfolded. © 2022, Emerald Publishing Limited.

Another Victim of COVID-19: Computer Science Education

Prior literature suggests that computer science education (CSE) was less affected by the pandemic than other disciplines. However, it is unclear how the pandemic affected the quality and quantity of students' studying in CSE. We measure the impact of the pandemic on the amount and spacing of students' studying in a large introductory computer science course. Spacing is defined as the distribution of studying over multiple sessions, which is shown to improve long-term learning. Using multiple regression models, we analyzed the total number of students' interactions with the eBook and the number of days they used it, as a proxy for studying amount and spacing, respectively. We compared two sequential winter semesters of the course, one during (Winter 2021) and one prior to the pandemic (Winter 2020). After controlling for possible confounders, the results show that students had 1,345.87 fewer eBook interactions and distributed their studying on 2.36 fewer days during the pandemic when compared to the previous semester prior to the pandemic. We also compared four semesters prior to the pandemic (Fall and Winter of 2018 and 2019) to two semesters during the pandemic (Fall 2020 and Winter 2021). We found, on average, students had 3,376.30 fewer interactions with the eBook and studied the eBook on 16.35 fewer days during the pandemic. Contrary to prior studies, our results indicate that the pandemic negatively affected the amount and spacing of studying in an introductory computer science course, which may have a negative impact on their education. © 2022 ACM.

The Multiple Waves of COVID-19 in Patients With Inflammatory Bowel Disease: A Temporal Trend Analysis.

BACKGROUND: Cases of coronavirus disease 2019 (COVID-19) have emerged in discrete waves. We explored temporal trends in the reporting of COVID-19 in inflammatory bowel disease (IBD) patients. METHODS: The Surveillance Epidemiology of Coronavirus Under Research Exclusion for Inflammatory Bowel Disease (SECURE-IBD) is an international registry of IBD patients diagnosed with COVID-19. The average percent changes (APCs) were calculated in weekly reported cases of COVID-19 during the periods of March 22 to September 12, September 13 to December 12, 2020, and December 13 to July 31, 2021. RESULTS: Across 73 countries, 6404 cases of COVID-19 were reported in IBD patients. COVID-19 reporting decreased globally by 4.2% per week (95% CI, -5.3% to -3.0%) from March 22 to September 12, 2020, then climbed by 10.2% per week (95% CI, 8.1%-12.3%) from September 13 to December 12, 2020, and then declined by 6.3% per week (95% CI, -7.8% to -4.7%). In the fall of 2020, weekly reporting climbed in North America (APC, 11.3%; 95% CI, 8.8-13.8) and Europe (APC, 17.7%; 95% CI, 12.1%-23.5%), whereas reporting was stable in Asia (APC, -8.1%; 95% CI, -15.6-0.1). From December 13, 2020, to July 31, 2021, reporting of COVID-19 in those with IBD declined in North America (APC, -8.5%; 95% CI, -10.2 to -6.7) and Europe (APC, -5.4%; 95% CI, -7.2 to -3.6) and was stable in Latin America (APC, -1.5%; 95% CI, -3.5% to 0.6%). CONCLUSIONS: Temporal trends in reporting of COVID-19 in those with IBD are consistent with the epidemiological patterns COVID-19 globally.

An International Reporting Registry of Patients With Celiac Disease and COVID-19: Initial Results From SECURE-CELIAC.

Surveillance Epidemiology Under Research Exclusion for Celiac Disease (SECURE-CELIAC) is an international, de-identified adult and pediatric database created to monitor and report on the severity of coronavirus disease 2019 (COVID-19) outcomes in patients with celiac disease (CD).

Relative Concentrations and Diffusion of COVID-19 across the United States in 2020

Les cartes topologiques simplifiées peuvent préserver la topologie des régions à l’intérieur d’une zone et offrir une variété de modes de présentation des variables géographiques, tout en attribuant un poids égal à toutes les régions. La topologie du Canada se prête bien à la présentation de l’information au moyen de cartes topologiques. Les premiers cas de COVID–19 au Canada ont été diagnostiqués en janvier 2020 ;le virus s’est répandu sur une grande partie du territoire en mars, la propagation atteignant un sommet d’avril à mai pour connaître ensuite une période d’accalmie ou de creux de juin à août, suivie d’une recrudescence plus marquée encore d’octobre à novembre. Bien que les provinces canadiennes les plus populeuses aient affiché le plus grand nombre de cas par 100 000 habitants, la propagation de la COVID–19 a atteint des sommets dans presque toutes les provinces. Dans les provinces atlantiques et les territoires du nord, les périodes de culmination ont été les plus courtes et les maximums enregistrés, les plus modestes, les chiffres les plus élevés se rapportant à une éclosion au Nunavut, en novembre. Le nombre de cas dans le centre du Canada s’est maintenu dans l’intervalle « modéré à élevé » pendant une grande partie de l’année, alors qu’il a connu une hausse importante dans l’ouest du pays en fin d’année. Simplified topological maps can preserve the topology of regions within an area and provide a variety of ways to display geographic variables while granting equal weight to all regions. Canada’s topology lends itself well to displaying information with topological maps. The first COVID-19 cases in Canada were identified in January 2020;the virus spread through much of the country in March, with a peak from April to May and a lull or trough in June–August, followed by a larger peak from October to November. Although Canada’s most populous provinces saw the most cases per 100,000 persons, nearly every province experienced peaks from COVID-19. Atlantic Canada and the northern territories experienced the shortest and smallest peaks, with the highest being a November outbreak in Nunavut. Cases in central Canada remained moderate to high for much of the year, while western Canada experienced high peaks near the end of the year.

Physician Practice Patterns in Holding Inflammatory Bowel Disease Medications due to COVID-19, in the SECURE-IBD Registry.

BACKGROUND: We aimed to describe physician practice patterns in holding or continuing IBD therapy in the setting of COVID-19 infection, using the Surveillance Epidemiology of Coronavirus Under Research Exclusion for Inflammatory Bowel Disease [SECURE-IBD] registry. METHODS: IBD medications that were stopped due to COVID-19 were recorded in the SECURE-IBD registry in addition to demographic and clinical data. We conducted descriptive analyses to understand characteristics associated with stopping IBD medications in response to active COVID-19 infection. RESULTS: Of 1499 patients, IBD medications were stopped in 518 [34.6%] patients. On bivariate and multivariable analyses, a diagnosis of ulcerative colitis or IBD-unspecified was associated with a lower odds of stopping medication compared with Crohn's disease (adjusted odds ratio [aOR] 0.6, 95% confidence interval [CI] 0.48, 0.75). When evaluating specific medications, 5-aminosalicylic acid was more likely to be continued [p <0.001] whereas anti-tumour necrosis factor therapy and immunomodulator therapy were more likely to be stopped [global p <0.001]. Other demographic and clinical characteristics did not affect prescription patterns. CONCLUSIONS: IBD medications other than immunomodulators were continued in the majority of IBD patients with COVID-19, in the international SECURE-IBD registry. Future studies are needed to understand the impact of stopping or continuing IBD medications on IBD- and COVID-19 related outcomes.

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

OBJECTIVE: We sought to evaluate COVID-19 clinical course in patients with IBD treated with different medication classes and combinations. DESIGN: Surveillance Epidemiology of Coronavirus Under Research Exclusion for Inflammatory Bowel Disease (SECURE-IBD) is a large, international registry created to monitor outcomes of IBD patients with confirmed COVID-19. We used multivariable regression with a generalised estimating equation accounting for country as a random effect to analyse the association of different medication classes with severe COVID-19, defined as intensive care unit admission, ventilator use and/or death. RESULTS: 1439 cases from 47 countries were included (mean age 44.1 years, 51.4% men) of whom 112 patients (7.8%) had severe COVID-19. Compared with tumour necrosis factor (TNF) antagonist monotherapy, thiopurine monotherapy (adjusted OR (aOR) 4.08, 95% CI 1.73 to 9.61) and combination therapy with TNF antagonist and thiopurine (aOR 4.01, 95% CI 1.65 to 9.78) were associated with an increased risk of severe COVID-19. Any mesalamine/sulfasalazine compared with no mesalamine/sulfasalazine use was associated with an increased risk (aOR 1.70, 95% CI 1.26 to 2.29). This risk estimate increased when using TNF antagonist monotherapy as a reference group (aOR 3.52, 95% CI 1.93 to 6.45). Interleukin-12/23 and integrin antagonists were not associated with significantly different risk than TNF antagonist monotherapy (aOR 0.98, 95% CI 0.12 to 8.06 and aOR 2.42, 95% CI 0.59 to 9.96, respectively). CONCLUSION: Combination therapy and thiopurines may be associated with an increased risk of severe COVID-19. No significant differences were observed when comparing classes of biologicals. These findings warrant confirmation in large population-based cohorts.MKH should be changed to MDK for co-last author line.