ABSTRACT
The COVID-19 pandemic impacted the life of people worldwide. We used a cross-sectional survey to evaluate the effects of pandemic on inflammatory bowel disease patients registered with Johns Hopkins. We assessed the methods used to minimize the risk of infection, coping mechanisms, changes in disease activity and management in the first 6 months of pandemic. Of the 405 patients who completed the questionnaire, 240 (58.8%) had Crohn's disease, 132 (32.6%) ulcerative colitis and 35 (8.6%) unclassified IBD.The median (IQR) age was 49 (28, 71). Two hundred seventy-three (67.4%) received biologics including patients on hospital-based (4.2%) infusions, outpatient-based infusions (26.7%) and home infusion (22.2%). Majority had other comorbidities, either heart (142/35.1%) or lung disease (19/ 4.7%), diabetes (22/5.4%), hypertension (77/19%), or obesity (13/3.2%). Most patients were at low risk for infection as they lived in a non-metropolitan area (291 patients, 71.8%), did not report close contact with a confirmed COVID-19 individual (373, 92.1%), did not travel to an area with high rates of COVID-19 (381, 94.1%) and did not use public transportation (379, 93.6%). All but 2 were taking protective measures such as use of N-95 mask (90, 22.2%), commercially (271, 66.9%) or homemade mask (208, 51.4%), sanitizer (363, 89.6%) or gloves (96, 23.7%). Additionally, patients used dietary/herbal supplements (55, 13.6%), dietary modifications (98, 24.2%) to support immunity (35, 8.6%), prevent an IBD flare (28, 6.9%), or minimize medications (48, 11.9%). The most common supplement used was Vitamin C (28, 50.9%), and D (42, 76.4%). Most (344, 84.7%) had no adjustments to their medications during pandemic, 31 (7.7%) discontinued their medication and 31 (7.7%) had to add a medication. Pandemic had, reportedly, no effect to the lives of 44 (20.9%) patients but 28 (13.3%) felt depressed, 70 (33.2%) anxious, 9 (4.3%) lost their income and 60 (28.4%) had other non-specified effects. The most common stress reduction techniques used were exercise (261, 64.4%), yoga (76, 18.8%), art therapy (23, 5.7%), music therapy (40, 9.9%), journaling (28, 6.9%), and guided Imagery (18, 4.4%). Fifty-eight (14.3%) used stress reduction medications. Eight (2%) reported SARS-CoV-2 infection. Median (IQR) age was 39 years (22,50)(Table 1). The majority had CD (6, 75%) and the infection was treated at home (6, 75%). One required admission to ICU. Infection led to worsening of the disease in 2 (25%). One (12.5%) discontinued IBD treatment. Our data suggest that most IBD patients followed low risk activities and were adherent to personal protective equipment and used stress reduction techniques and dietary supplements to cope with pandemic and avoid flares. Infection rates were low and the majority did not require admission to the hospital. In the majority infection did not cause an IBD exacerbation. (Table Presented)
ABSTRACT
Background: Data on coronavirus disease 2019 (COVID–19) and its clinical implications on inflammatory bowel disease (IBD) are rapidly evolving. We performed a systematic review and meta-analysis to investigate clinical characteristics, therapeutic options and outcomes in IBD patients with COVID-19. Methods: Wesearched PubMed, EMBASE, Cochrane Central, Clinicaltrials.gov, Web of Science, MedRxiv and Google Scholar from inception through October 2020. We included cohort studies that involved IBD patients with confirmed COVID-19. Two investigators independently screened the studies for inclusion and extracted the data. Data were collected on the prevalence of COVID-19 among patients with IBD, patient characteristics, pre-infection treatments for IBD, co-morbidities, hospitalization,intensive care unit (ICU) admission, and death. Results: Twenty-three studies with 51,643 IBD patients and 1449 with COVID-19 met our inclusion criteria. In 14 studies (n = 50,706) that included IBD patients with and without COVID-19, the infection rate was 1.01%. Of IBD patients with COVID-19, 51.3% had Crohn’s disease, 41.5% had ulcerative colitis, and 6.4% had indeterminate colitis. Mean ages for patients ranged from 18 to 85 years and 60.71% were females. Nine studies (n = 687) reported outcomes according to IBD therapy received. Oral and rectal mesalamine was used in 23.4% of patients with 44.1% requiring hospitalization, 8.7% ICU admission, and 6.8% deaths (Table). Immunomodulators (methotrexate, azathioprine, 6-mercaptopurine) were used in 12.4% of patients with 37.6% requiring hospitalization, 3.5% ICU admission, and 2.4% deaths. Anti-tumor necrosis factor (TNF) therapies were used in 37.2% patients with 12.9% requiring hospitalization, 1.2% ICU admission, and 0.8% deaths. Outcomes related to corticosteroid use could not be delineated with available data. Conclusions: The infection rate for COVID-19 in IBD patients was lower than that of general population. Use of mesalamine was significantly associated with worse hospitalization outcomes, while use of anti-TNFs was associated with favorable hospitalization outcomes. Further investigation clarifying the mechanisms of these disparate observations could help identify risk and adverse outcome-mitigating strategies for patients with IBD.(Table Presented)