ABSTRACT
Introduction: In March 2020, Coronavirus Disease 2019 (COVID-19) was declared a pandemic. Elective healthcare services were reorganised worldwide. This study addresses the impact of measures taken in the early stages of the pandemic on diagnosing Upper Gastrointestinal (UGI) and Hepatopancreaticobiliary (HPB) malignancies in a university teaching hospital. Aims: To ascertain whether fewer cases of UGI/HPB cancers were detected, the differences in inpatient and outpatient diagnosis and whether there was an increased detection of later stage disease during the pandemic than in the preceding year. Methods: This was a retrospective cohort study conducted in Tallaght University Hospital in Ireland. All new diagnoses of UGI/HPB cancers, excluding hepatocellular carcinomas, are managed at a weekly Multidisciplinary Team (MDT) meeting. Data was retrieved from the MDT database and medical records and analysed using IBM SPSS Statistics V20. Results: 111 cases were detected. There was no significant difference in the proportion of cases detected in the overall post-COVID period (n=53, 47.7%) compared to the Pre-COVID period (n=58, 52.3%) (p=0.7884). When COVID-19 cases were at their highest levels in Ireland, we observed a significant drop in new UGI/HPB cases detected compared to the pre-COVID period. This was mitigated in the third quarter of 2020, when transmission was depressed and a sharp increase in detection of UGI/HPB cases was observed. The variance of distribution of cases per quarter in the two periods was statistically significant with a P-value of 0.0001. There was a non-significant trend towards fewer diagnoses of early cancer (stage ≤2) in the Post- COVID period (21% v 26%) (p=0.6416). The proportion of patients diagnosed as an inpatient did not differ between the two periods, p=.739. Discussion: As fears about aerosolization abated, endoscopy services quickly increased the number of scopes performed after the initial reduction at the start of the pandemic. There are several limitations to this study, however it does lead us to conclude that our fears regarding cancer diagnosis in the postpandemic period did not materialise. It also offers solace that when transmission of COVID- 19 is depressed, as it was in Ireland in Q3 2020 before the peak of the second wave in Q4 2020, that outpatient services can quickly escalate their level of activity and detect cancers that were missed with no significant change in stage. A further observation is that when lockdown measures in Ireland were reintroduced in winter 2020/2021 but outpatient services were kept open, a similar reduction in detections was observed compared to when they were closed. Therefore, the question may be posed if the primary driver of reduced detection of UGI/HPB cancers is primary care services being overwhelmed with pandemic work rather than a reduction in outpatient services . (Table Presented) (Figure Presented)
ABSTRACT
Objective: Patients with inflammatory bowel disease (IBD) have attenuated responses to current vaccinations. There is a limited body of evidence suggesting patients with IBD receiving TNF antagonists have an attenuated response to vaccination against COVID-19. We sought to determine the impact of IBD and various medications for the treatment of IBD on antibody responses to vaccination against COVID-19. Design: Patients with IBD (n=270) and healthy controls (HC, n=116) were recruited prospectively and quantitative antibody responses assessed following COVID-19 vaccination. The impact of IBD and medications for treatment of IBD on vaccine response rates was investigated. Results: All HC seroconvert post complete vaccination with two vaccine doses [100%]. A small proportion of patients with IBD failed to seroconvert [2%]. Median anti-spike protein (SP) immunoglobulin (Ig)G levels post one vaccination and complete vaccination in our IBD cohort was significantly lower than HC [2,613 AU/mL versus 6,871 AU/mL, p=<0.001] [Figure 1]. A diagnosis of IBD was independently associated with lower anti-SP IgG levels [β coefficient -0.2, p = 0.001] whereas use of mRNA vaccines was independently associated with higher anti-SP IgG levels [β coefficient 0.25, p = < 0.001]. Patients with IBD receiving anti-TNF therapy had significantly lower anti-SP IgG levels [2444.6 AU/mL] than IBD patients not receiving these agents [3867.6 AU/mL] [p = < 0.001]. Patients with IBD not receiving TNF inhibitors still showed attenuated responses compared to HC receiving a similar vaccine [p = 0.001] [Figure 2]. 58 patients had an additional follow-up serology sample at a median of 12 weeks to complete vaccination to allow assessment of the durability of the response after their initial post-vaccination IgG level. There was a significant drop in IgG levels from 3952.85 AU/mL at the first timepoint checked post-complete vaccination to 921.1 AU/mL (343.1 – 2102.7) on follow-up sampling (p = <0.001). Median anti-SP IgG levels were numerically lower in our cohort receiving anti-TNF therapy (794.8 AU/mL) compared to those not receiving anti-TNF therapy (3136.9 AU/mL) on final follow-up samples (p =0.28). HC participants with previous COVID-19 infection (n= 5) had significantly higher anti-SP IgG levels post complete vaccination (20,719.6 AU/mL) compared to IBD patients (n=4) with prior infection (3,938.2 AU/mL) (p = < 0.001). Conclusions: Patients with IBD have attenuated serological responses to SARS-CoV-2 vaccination. Patients with IBD who do not seroconvert post-vaccination against COVID-19 are a particularly vulnerable cohort. Use of anti-TNF therapy negatively impacts anti-SP IgG levels. Impaired responses to vaccination in our study highlights the importance of booster vaccination programmes for patients with IBD. (Figure Presented) Differences in median IgG levels across three time points (Figure Presented) Differences in median anti-SP Levels dependent on medication for treatment of IBD.