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)
ABSTRACT
Background: During The Covid-19 Pandemic, The General Population Has Been Subject To Heightened Stress, Anxiety, Depression, And Fear Of The Virus. However, The Impact Of Covid-19 On These Psychometric Factors Have Not Been Formally Assessed In Patients With Inflammatory Bowel Disease (Ibd), Specifically Those On Biologic Therapies. The Aim Of This Study Was To Examine The Relationship Between Fear Of Covid-19 And Biologic Usage In Ibd Patients. Methods: Adult Ibd And Non-Ibd Patients Were Recruited From An Academic Clinic And Via Social Media Outlets. Patients Were Administered A Qualtrics Survey Assessing Demographics Disease Characteristics, And Perceptions Around Covid-19. The Validated Fear Of Covid-19 Scale (Fcv-19s), Perceived Stress Scale (Pss), And Hospital Anxiety And Depression Scale (Hads) Were Used To Assess Fear Of Covid-19, Stress, Anxiety And Depression, Respectively. Analyses Evaluated The Associations Between These Psychological Experiences, Ibd Diagnosis, And Medication Usage. Results: There Were 399 Participants (17% Crohn’S Disease;43% Ulcerative Colitis;4% Ibd-Unclassified;36% Non-Ibd). Ibd Participants Had Higher Levels Of Stress (P<.01), Anxiety (P<.01), Depression (P<.01), And Fear Of Covid-19 (P<.01) Compared With Non-Ibd Participants. When Asked About Perceived Likelihood Of Contracting Covid-19, Ibd Participants More Often Responded With A “High” Or “Extreme” Likelihood (26.3% Vs. 9.1%;P<.01). Among The Risk Perception Screening Domains, 77.9% And 45.9% Of Ibd Participants On Biologics Responded “Very” Or “Extremely” Affirmatively To Questions Related To Perceived Level Of Precaution Needed To Avoid Contracting Covid-19 And Perceived Severity Of Infection If Contracted, Respectively. Additionally, 41.5% Of Ibd Participants On Biologics Were More Likely To Report Feeling That Their Ibd Medications Made Them “Extremely” Or “Very” Vulnerable, Compared With Only 20.3% Of Ibd Participants Not On Biologic Therapy. Use Of Biologic Therapy Was Associated With Higher Levels Of Stress (P=.011), Anxiety (P<.01), And Fear Of Covid-19 (P<.01). Due To Concerns Of Covid-19, 5.6% Decided To Defer Starting Biologic Treatment, While 2.0% Decided To Discontinue Biologic Medication. Conclusion: This Study Is One Of The First To Evaluate The Mental Health Of Ibd Patients During The Covid-19 Pandemic And Uniquely Evaluates Psychological Variables As They Relate To Biologic Usage. Fear Of Covid-19, Anxiety, And Perceived Stress Were Strongly Correlated With Biologic Usage In Ibd Patients, Suggesting That Participants Using Biologic Therapy Felt More Susceptible To Infection. Furthermore, These Findings Have Implications On Patient Adherence To Immunosuppressive Medications During The Covid-19 Pandemic, Which Should Be Considered During Therapy-Related Discussions Between Physicians And Ibd Patients (Table Presented)