ABSTRACT
Introduction: Patients with inflammatory bowel disease (IBD) might be at risk of developing severe courses of respiratory tract infections including SARS-CoV-2 due to their immunotherapies. This risk could increases with the age of our patients. Aims & Methods: This study is focused on the question whether patients with IBD who receive immunotherapies are more vulnerable to respiratory tract infections, including SARS-CoV-2, in comparison to IBD patients without immunotherapies and to the general population. Further, we investigated, if age is a predictor for severe respiratory tract infections. We analysed data regarding respiratory tract infections that were collected in our IBD registry in 2020. We compared moderate respiratory symptoms (coughing, rhinitis or sore throat) to severe respiratory symptoms (fever, chills or anosmia) in 1091 IBD-patients with or without immunotherapies. We distinguished between the type of immunotherapy and the patients' age (younger than 50 years or older). Regarding SARS-CoV-2, we compared our data with corresponding published data from the healthy general population in the same city (Munich/ Germany) over the same time frame (April to June 2020). Patients were tested for SARS-CoV-2 immunoglobulins (Ig). For statistical analyses we applied the Shapiro-Wilk-test for Gaussian distribution, the t-test or the Mann-Whitney-U test, and for frequency distribution the Chi-square test or Fisher's exact test. For investigation of factors that could have an influence on the occurrence of symptoms we used logistic regression models. Result(s): Overall symptoms of respiratory tract infections occurred equally frequenty in patients with immunotherapies as compared to those without. Older age, TNF-inhibitor and ustekinumab treatment showed a significant protective role in preventing respiratory tract infections: Symptoms of respiratory tract infections in IBD patients occurred less frequently in patients treated with anti-TNF (p=0.03), infliximab (p=0.01), ustekinumab (p=0.03), but not vedolizumab, as compared to patients with no immunotherapy. Symptomatic, PCR-proven COVID-19 infections occurred in 0.45% of all IBD patients. SARS-CoV-2 IgG-testing showed a three times higher actual incidence of 1.8%. This is identical to the general population of Munich within the same timeframe. Whilst more than 3% of all COVID-19 subjects of the general population died during the first wave of the pandemic, none of our IBD-patients died, needed referral to the ICU or oxygen treatment. Conclusion(s): Contrary to our current assumption, older age and the treatment with TNF-inhibitors or ustekinumab showed a protective role in preventing respiratory tract infections in IBD patients. Moreover, IBD patients, predominantly treated with immunotherapies, are just as suscep tible to SARS-CoV-2 infection as the normal population. A reduced rate of COVID-19 deaths in IBD patients was observed, compared to the general population. Therefore, no evidence was found to suggest that IBD medication should be withheld, and adherence to medication should be encouraged to prevent flares at any age and in times of the SARS-CoV-2 pandemic.