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1.
Medical Science Monitor ; 28 (no pagination), 2022.
Article in English | EMBASE | ID: covidwho-2217606

ABSTRACT

Background: The aim of the study was to assess the rate of COVID-19 vaccination and the attitudes toward receiving COVID-19 vaccination among patients with inflammatory bowel disease (IBD) in Poland. An important aim of the study was to determine why some people get vaccinated and others refuse to do so. Material/Methods: This was a single-center, prospective survey. The study included 267 IBD patients who agreed to complete an anonymous questionnaire comprising 31 questions. Result(s): We found that 71.2% of the IBD patients had been vaccinated. The history of COVID-19 was associated with a lower vaccination rate (16.9% vs 36.8%;P=0.001), regardless of IBD severity. In the vaccinated group, there were more vaccinated people among household members (90.4% vs 43.4%;p<0.001) and friends (52.9% vs 22.4%;P<0.001). Family safety (71.1%), the desire to avoid COVID-19 (67.9%), social responsibility (60.5%), the desire to return to normal life (51.6%), and faith in vaccination as such (43.2%) were the most common reasons for vaccination. The most common cause of non-vaccination was concern about adverse effects (50.0%), including long-term adverse effects (36.8%), and about the possible exacerbation of gastroenterological disease (34.2%). Conclusion(s): IBD patients are more likely to be vaccinated against SARS-CoV-2 than the rest of the population in Poland. Young age, low socioeconomic status, low education, and living in the countryside were factors associated with lower vaccination rates. Family and friends had the greatest influence on the decision to vaccinate, but the influence of the mass media was very small. Copyright © 2022 International Scientific Information, Inc.. All rights reserved.

2.
Liu, Z.; Le, K.; Zhou, X.; Alexander, J. L.; Lin, S.; Bewshea, C.; Chanchlani, N.; Nice, R.; McDonald, T. J.; Lamb, C. A.; Sebastian, S.; Kok, K.; Lees, C. W.; Hart, A. L.; Pollok, R. C.; Boyton, R. J.; Altmann, D. M.; Pollock, K. M.; Goodhand, J. R.; Kennedy, N. A.; Ahmad, T.; Powell, N.; Islam, M.; Croft, N.; Cipriano, B.; Francia, C.; Khalid, N.; Kingston, A.; Lee, I.; Lehmann, A.; Naik, K.; Samuels, K.; Plaatjies, N.; Khatun, H.; Bokth, F.; Pabriaga, E.; Saich, R.; Cousins, H.; Fraser, W.; Thomas, R.; Brown, M.; White, B.; Kirkineziadis, N.; Tilley, B.; Porter, P.; Bryant, R.; Robaczewska, N.; Muhammed, R.; Bi, R.; Cotter, C.; Grove, J.; Hong, K.; Howman, R.; Clayton, S.; Rogers, L.; Sultan, S.; Rooney, M.; Cottrill, C.; Singh, S.; Dawe, C.; Hull, R.; Silva, N.; Chadwick, J.; Robertson, L.; Manning, J.; Finlayson, L.; Roebuck, A.; Dawson, J.; Sonwalkar, S.; Chambers, N.; Robinson, M.; Haigh, A.; Matapure, L.; Raine, T.; Kapizioni, C.; Strongili, K.; Thompson, T.; Ahmed, M.; Kontos, C.; Dawson, C.; Bourges, C.; Barbutti, I.; Gozzard, M. E.; Hendy, P.; Bull, R.; Costa, P.; Davey, L.; Hannington, H.; Nundlall, K.; Martins, C.; Avanzi, L.; Carungcong, J.; Barr, S.; Appleby, R.; Johnson, E.; Shakweh, E.; Phillis, K.; Gascoyne, R.; Crowder, A.; Whileman, A.; London, I.; Grounds, J.; Martin, E.; Pajak, S.; Price, J.; Cawley, K.; Powell, S.; Kearsley, N.; Dhar, A.; Brown, E.; Cowton, A.; Warner, B.; Stuart, C.; Lacey, L.; de Silva, S.; Allcock, C.; Harvey, P.; Jones, L.; Cooke, E.; Slater, J.; King, D.; Brooks, J.; Baker, P.; Beadle, H.; Cruz, C.; Potter, D.; Collum, J.; Masters, F.; Kumar, A.; Coetzee, S.; Peiu, M.; Icke, B.; Raj, M.; Gaynor, E.; Chadokufa, S.; Huggett, B.; Meghari, H.; El-Khouly, S.; Kiparissi, F.; Girshab, W.; Russell-Walker, L.; Jackson, C.; Sidler, S.; Claridge, A.; Fowler, E.; McCafferty, L.; Haxton, L.; Irving, P.; Christodoulides, K.; Clifford, A.; Dawson, P.; Honap, S.; Lim, S.; Luber, R.; Mahiouz, K.; Meade, S.; Raymode, P.; Reynolds, R.; Stanton, A.; Tripoli, S.; Hare, N.; Odukwe, S.; Balachandran, S.; North, E.; North, J.; Browne, B.; Cordle, J.; Jameson, E.; Siaw, Y. H.; Manzano, L.; Segal, J.; Al-Bakir, I.; Khakoo, I.; Portukhay, S.; Thoua, N.; Davidson, K.; Miah, J.; Canclini, L.; Hall, A.; Furreed, H.; Mitchell-Inwang, C.; Hayes, M.; Myers, S.; Talbot, A.; Turnbull, J.; Whitehead, E.; Stamp, K.; Pattinson, A.; Mathew, V.; Sherris, L.; Wilcox, J.; Ramachandran, S.; Robertson, H.; Harvey, A.; Hicks, L.; Byrne, T. M.; Cabreros, L.; Downing-Wood, H.; Hunter, S.; Saifuddin, M. A.; Prabhudev, H.; Balarajah, S.; Krucznski, J.; Driva, K.; D'Mello, A.; Shah, P.; Castro-Seoane, R.; Ibraheim, H.; Constable, L. E.; Lo, J. W.; Torkizadeh, M.; Hermangild, S. K.; Sutherland, H.; Wilhelmsen, E.; Mackintosh, K.; Verma, A. M.; Sebastian, J.; Peerally, M. F.; Guerdette, A. M.; Coburn, S.; Novem lam, C. Y.; Durrant, D.; Schaefer, B.; Serna, S.; Shahzad, M.; Kent, A.; Choong, L. M.; Pantaloni, B.; Ravdas, P.; Vadamalayan, B.; Foley, S.; Arnold, B.; Heeley, C.; Lovegrove, W.; Sowton, D.; Allsop, L.; Gregory, H.; Gill, M.; Holmes, M.; Balan, V.; Turner, S.; Smith, P. J.; Steel, A.; Bretland, G.; King, S.; Lofthouse, M.; Rigby, L.; Subramanian, S.; Tyrer, D.; Martin, K.; Probert, C.; Kamperidis, N.; Adedoyin, T.; Baden, M.; Chacko, F.; Young, L.; Cicchetti, M.; Saifuddin, M.; Yesupatham, P.; Gowda, R.; Williams, M.; Kemp, K.; Akhand, R.; Gray, G.; John, A.; John, M.; Mohammed, T.; Sathe, D.; Jones, N.; Soren, J.; Sprakes, M.; Burton, J.; Kane, P.; Lupton, S.; Bartholomew, J.; Denis, E.; Daniels, A.; MacFaul, G.; Scaletta, D.; Siamia, L.; Williams, F.; Green, C.; Ver, Z.; Lamb, C.; Doona, M.; Hogg, A.; Jeffrey, L.; King, A.; Speight, R. A.; Doyle, J.; Owen, R.; Haworth, J.; Patterson, L.; Varnaulasingam, V.; Mowat, C.; Rice, D.; MacFarlane, S.; MacLeod, A.; Mohammed, S.; Murray, S.; Elliott, A.; Anne Morris, M.; Coke, L.; Hindle, G.; Kolokouri, E.; Wright, C.; Lee, C.; Ward, N.; Dann, A.; Lockett, M.; Cranfield, C.; Jennings, L.; Srivastava, A.; Ward, L.; Jeynes, N.; Ranga, P.; Rajasekhar, P.; Gallagher, L.; Ward, J.; Basnett, R.; Murphy, J.; Parking, L.; Lawson, E.; Short, S.; Devadason, D.; Moran, G.; Khan, N.; Tarr, L.; Olivia, C.; Warbarton, S.; Kelly, S.; Limdi, J.; Goulden, K.; Javed, A.; McKenzie, L.; Melville, J.; Liu, E.; Sabine, J.; Jacob, P.; McSorland, D.; Schofield, N.; Cornwall, L.; Quirke, J.; Crook, E.; Turner, A.; Bhandari, P.; Baker-Moffatt, M.; Dash, J.; Le Poidevin, A.; Downe, H.; Bombeo, L.; Blackman, H.; Smith, R.; Wiles, A.; Bloxham, H.; Dias, J.; Nadar, E.; Curgenven, H.; Gilham, E.; Macdonald, J.; Finan, S.; McMeeken, F.; Mahmood, M.; Shields, S.; Seenan, J. P.; DeSilva, D.; Malkakorpi, S.; Carson, R.; Lawrence, H.; Boateng, O.; Kpodo, F.; Whiteoak, S.; Edger-Earley, K.; Vamplew, L.; Samways, J.; Roffe, S.; Ingram, S.; James, J.; Botfield, S.; Hammonds, F.; James, C.; Berry, Z.; Aspinall, G.; Hawkins, S.; Parkinson, M.; Gardner-Thorpe, H.; Marriott, S.; Redstone, C.; Windak, H.; Adam, A. M.; Mabb, H.; Stevenson, E.; Record, J.; Murray, C.; Diaba, C.; Joseph, F.; Pakou, G.; Gleeson, Y.; Nunag, A.; Berrill, J.; Stroud, N.; Pothecary, C.; Roche, L.; Turner, K.; Deering, L.; Israel, L.; Baker, E.; Nash, M.; Fagbemi, A.; Jennings, F.; Mayor, I.; Wilson, J.; Wheeler, A.; Phillips, N.; Gordon, J.; Levell, E.; Zagalo, S.; Hoad, I.; Anil, B.; Russell, R.; Henderson, P.; Millar, M.; Alexakis, C.; Michalak, N.; Marriott, C.; Stone, S.; Pristopan, V.; Saunders, J.; Burton, H.; Cambridge, V.; Clark, T.; Ekblad, C.; Hierons, S.; Katebe, J.; Saunsbury, E.; Perry, R.; Brookes, M.; Davies, K.; Green, M.; Plumbe, A.; Ormerod, C.; Christensen, H.; Howlett, H.; Keen, A.; Ogor, J.; Greenhaigh, M.; Knowles, K.; Yin, S.; Poulaka, M.; Anthony, A.; Newitt, E.; Trim, F.; Casey, R.; Seymour, K.; Reed, C.; Joy, L.; Fogden, E.; Russell, K.; Hussain, S.; Phillips, A.; Abdulla, M.; Butterworth, J.; Adams, C.; Carnahan, M.; Buckingham, E.; Childs, D.; Magness, A.; Stickley, J.; Motherwell, N.; Tonks, L.; Gibson, H.; Wistance, K.; Thomas, C.; Brinkworth, E.; Connor, L.; Cook, A.; Rees, T.; Harford, R.; Farley, S.; Jones, M.; Wesley, E.; Moss, A.; Lucas, J.; Lorimer, C.; Oleary, M.; Dixon, M.; Goodchild, F.; Twenlow, R.; Pawley, C.; Ramadas, A.; Tregonning, J.; Okeke, O.; Jackson, W.; Koumoutsos, I.; George, V.; Kunhunny, S.; Laverick, S.; Anderson, I.; Smith, S.; Joyce, J.; et al..
The Lancet Gastroenterology and Hepatology ; 8(2):145-156, 2023.
Article in English | EMBASE | ID: covidwho-2211788

ABSTRACT

Background: Anti-TNF drugs, such as infliximab, are associated with attenuated antibody responses after SARS-CoV-2 vaccination. We aimed to determine how the anti-TNF drug infliximab and the anti-integrin drug vedolizumab affect vaccine-induced neutralising antibodies against highly transmissible omicron (B.1.1.529) BA.1, and BA.4 and BA.5 (hereafter BA.4/5) SARS-CoV-2 variants, which possess the ability to evade host immunity and, together with emerging sublineages, are now the dominating variants causing current waves of infection. Method(s): CLARITY IBD is a prospective, multicentre, observational cohort study investigating the effect of infliximab and vedolizumab on SARS-CoV-2 infection and vaccination in patients with inflammatory bowel disease (IBD). Patients aged 5 years and older with a diagnosis of IBD and being treated with infliximab or vedolizumab for 6 weeks or longer were recruited from infusion units at 92 hospitals in the UK. In this analysis, we included participants who had received uninterrupted biological therapy since recruitment and without a previous SARS-CoV-2 infection. The primary outcome was neutralising antibody responses against SARS-CoV-2 wild-type and omicron subvariants BA.1 and BA.4/5 after three doses of SARS-CoV-2 vaccine. We constructed Cox proportional hazards models to investigate the risk of breakthrough infection in relation to neutralising antibody titres. The study is registered with the ISRCTN registry, ISRCTN45176516, and is closed to accrual. Finding(s): Between Sept 22 and Dec 23, 2020, 7224 patients with IBD were recruited to the CLARITY IBD study, of whom 1288 had no previous SARS-CoV-2 infection after three doses of SARS-CoV-2 vaccine and were established on either infliximab (n=871) or vedolizumab (n=417) and included in this study (median age was 46.1 years [IQR 33.6-58.2], 610 [47.4%] were female, 671 [52.1%] were male, 1209 [93.9%] were White, and 46 [3.6%] were Asian). After three doses of SARS-CoV-2 vaccine, 50% neutralising titres (NT50s) were significantly lower in patients treated with infliximab than in those treated with vedolizumab, against wild-type (geometric mean 2062 [95% CI 1720-2473] vs 3440 [2939-4026];p<0.0001), BA.1 (107.3 [86.40-133.2] vs 648.9 [523.5-804.5];p<0.0001), and BA.4/5 (40.63 [31.99-51.60] vs 223.0 [183.1-271.4];p<0.0001) variants. Breakthrough infection was significantly more frequent in patients treated with infliximab (119 [13.7%;95% CI 11.5-16.2] of 871) than in those treated with vedolizumab (29 [7.0% [4.8-10.0] of 417;p=0.00040). Cox proportional hazards models of time to breakthrough infection after the third dose of vaccine showed infliximab treatment to be associated with a higher hazard risk than treatment with vedolizumab (hazard ratio [HR] 1.71 [95% CI 1.08-2.71];p=0.022). Among participants who had a breakthrough infection, we found that higher neutralising antibody titres against BA.4/5 were associated with a lower hazard risk and, hence, a longer time to breakthrough infection (HR 0.87 [0.79-0.95];p=0.0028). Interpretation(s): Our findings underline the importance of continued SARS-CoV-2 vaccination programmes, including second-generation bivalent vaccines, especially in patient subgroups where vaccine immunogenicity and efficacy might be reduced, such as those on anti-TNF therapies. Funding(s): Royal Devon University Healthcare NHS Foundation Trust;Hull University Teaching Hospital NHS Trust;NIHR Imperial Biomedical Research Centre;Crohn's and Colitis UK;Guts UK;National Core Studies Immunity Programme, UK Research and Innovation;and unrestricted educational grants from F Hoffmann-La Roche, Biogen, Celltrion Healthcare, Takeda, and Galapagos. Copyright © 2023 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license

3.
J Gastroenterol Hepatol ; 2022 Sep 06.
Article in English | MEDLINE | ID: covidwho-2192756

ABSTRACT

BACKGROUND: Coronavirus disease 2019 (COVID-19) vaccination is recommended for patients with inflammatory bowel disease (IBD); however, suppressed immune responses have been reported for fully vaccinated patients under immunosuppressive therapy, mainly from Western countries. We prospectively analyzed antibody titers of IBD patients in Asia induced by two-dose and additional dose of messengerRNA COVID-19 vaccine. METHODS: After measuring high-affinity antibody titers, factors associated with antibody titers were identified by multiple regression analyses using the following covariates: sex, age (≥60 or <60 years), disease type (Crohn's disease or ulcerative colitis), vaccine type (BNT162b2 or mRNA-1273), time from second/third vaccination, molecular-targeted agent (anti-tumor necrosis factor [TNF] agents, ustekinumab, vedolizumab, tofacitinib, or no molecular-targeted agents), thiopurine, steroid, and 5-aminosalicylic acid. RESULTS: Among 409 patients analyzed, mean titer was 1316.7 U/mL (SD, 1799.3); 403 (98.5%) were judged to be seropositive (≥0.8 U/mL), and 389 (95.1%) had neutralizing antibodies (≥15 U/mL). After the third vaccination, mean titer raised up to 21 123.8 U/mL (SD, 23 474.5); all 179 were seropositive, and 178 (99.4%) had neutralizing antibodies. In 248 patients with genetic data, there was no difference in mean titer after two/third doses between carriers and non-carriers of HLA-A24 associated with severe disease during COVID-19 infection. A multiple regression analyses using covariates revealed that older age, vaccine type (BNT162b2), time from second/third dose, anti-TNF agent, tofacitinib, and thiopurine were independently associated with lower antibody titers. CONCLUSIONS: Our findings further support the recommendation for COVID-19 vaccination in patients under immunosuppressive therapy, especially additional third dose for patients receiving anti-TNF agents and/or thiopurine or tofacitinib.

4.
Diagnostics ; 13(1):37, 2023.
Article in English | ProQuest Central | ID: covidwho-2199869

ABSTRACT

Mobile health has the potential to transform the management of chronic illnesses, expanding treatment from a purely clinic-based approach to a more patient-centered delivery of care. For patients with inflammatory bowel disease (IBD), a condition characterized by a relapsing and remitting course, adoption of mobile health strategies can promote improved quality of care delivery and clinical outcomes. Benefits of mobile health applications for IBD include tracking symptoms to guide disease management, coordinating data exchange across clinical care providers, increasing communication between patients and the care team, and providing educational materials to increase patient engagement and satisfaction. In this review, we present the current offerings for telemedicine systems and mobile applications designed for patients with IBD and discuss the potential advantages and limitations of utilizing mobile health in the care of these patients.

5.
Therapeutic Advances in Gastroenterology ; 15(no pagination), 2022.
Article in English | EMBASE | ID: covidwho-2195420

ABSTRACT

Background: Medication adherence in inflammatory bowel disease (IBD) is crucial, particularly during pregnancy. Unplanned pregnancies are common;therefore, efforts to maximise adherence should not be restricted to pregnant women. Objective(s): We aimed to assess medication adherence in women with IBD of childbearing age, regardless of their reproduction plans. Design(s): We performed a multi-centre pilot questionnaire study of women with IBD age 18-45 years. Method(s): Survey questions included patient demographics, disease history, and validated assessments of IBD and pregnancy knowledge, medication adherence and quality of life. The primary outcome was rates and predictors of medication adherence. Result(s): In all, 72 women [58.3% Crohn's disease (CD) and 37.5% ulcerative colitis] completed the survey. The median patient age was 30 years [interquartile range (IQR): 24.8-36.0) and 37.5% had children. Medication adherence was high (84%;median Medication Adherence Report Scale: 19.0/20;IQR: 17.0-20.0). Knowledge scores were adequate for both the Crohn's and Colitis Knowledge (CCKnow;median: 15.5/30;IQR: 12.3-18.0) and Crohn's and Colitis Pregnancy Knowledge (CCPKnow;median: 8.0/17;IQR: 4.0-11.0). Disease knowledge was predictive of high medication adherence (CCPKnow: p = 0.02;CCKnow: p 0.01). Higher adherence was significantly associated with a diagnosis of CD (p = 0.01), exposure to biological agents (p = 0.03) and immunomodulators (p = 0.04), childbearing after diagnosis with IBD (p = 0.03), and correctly understanding the importance of delivery modality (p = 0.02) and IBD activity in pregnancy (p = 0.01). Conclusion(s): Following dedicated education at the IBD clinic, medication adherence, disease-specific and pregnancy-specific knowledge in women with IBD of childbearing age tends to be high. Unplanned pregnancies are frequent;therefore, we should aim to maximise medication adherence in all women of childbearing age to optimise maternofoetal outcomes if unexpected pregnancies occur. Copyright © The Author(s), 2022.

6.
Nature Reviews Drug Discovery ; 22(1):8, 2023.
Article in English | EMBASE | ID: covidwho-2185669
7.
Dig Liver Dis ; 2023.
Article in English | PubMed | ID: covidwho-2178046

ABSTRACT

AIM: Assess the characteristics of break through COVID-19 in Inflammatory Bowel Disease (IBD) patients, despite complete vaccination. METHODS: Patients who reported a COVID-19 at least 3 weeks after complete vaccination were asked to answer an on-line anonymous questionnaire which included patient and disease characteristics, vaccination history, and the evolution of COVID-19. RESULTS: Among 3240 IBD patients who reported complete vaccination between 1st May 2021 and 30thJune 2022, 402 (12.4%) were infected by SARS Cov-2 [223 male, 216 Crohn's disease (CD), 186 Ulcerative Colitis (UC), mean (SD) age 42.3 (14.9) years, mean (SD) IBD duration 10.1 (9.7) years]. Three hundred and sixty-nine patients (91.8%) were infected once and 33 (8.2%) twice. The mean (SD) time between last vaccination and infection was 4.1 (1.6) months. Overall, 351 (87.3%) patients reported mild constitutional and/or respiratory symptoms, 34 (8.4%) were asymptomatic and only 17 patients (4.2%) required hospitalization. Of hospitalized patients, 2 UC patients died of COVID-19 pneumonia. The remaining hospitalized patients did not need high flow oxygen supply or ICU admission. CONCLUSIONS: A minority of completely vaccinated IBD patients developed COVID-19 which evolved with mild symptoms and a favorable outcome. These results reinforce the importance of vaccination especially in vulnerable populations.

8.
Infection Prevention in Practice ; : 100267, 2022.
Article in English | ScienceDirect | ID: covidwho-2165417

ABSTRACT

Summary Background Whether healthcare workers with inflammatory bowel disease (IBD) are at increased risk of Novel coronavirus disease (COVID-19) due to occupational exposure is unknown. Aim To assess the risk of COVID-19 in healthcare workers with IBD. Methods A case control study enrolled 326 healthcare workers with IBD from 17 GETAID centres and matched non-healthcare workers with IBD controls (1:1) for gender, age, disease subtype and year of diagnosis. The study period was year 2020 during the COVID-19 outbreak. Results In total, 59 COVID-19 were recorded among cases (n = 32) and controls (n = 27), including 2 severe COVID-19 (requiring hospitalization, mechanic ventilation) but no death. No difference was observed between healthcare workers and controls regarding the overall incidence rates of COVID-19 4.9 ± 2.2 vs. 3.8 ± 1.9 per 100 patient-semesters, P = 0.34) and the overall incidence rates of severe COVID-19 (0.6 ± 7.8 vs. 0.3 ± 5.5 per 100 patient-semesters, P = 0.42). In multivariate analysis in the entire study population, COVID-19 was associated with patients with body mass index > 30 kg/m2 (HR = 2.48, 95%CI [1.13–5.44], P = 0.02). Conclusion Healthcare workers with IBD do not have an increased risk of COVID-19 compared with other patients with IBD.

9.
Eksperimental'naya i Klinicheskaya Gastroenterologiya ; 200(4):184-191, 2022.
Article in Russian | Scopus | ID: covidwho-2164639

ABSTRACT

The article discusses clinical case of a new coronavirus infection in a patient with a severe course of Crohn's disease (CD) in a long anamnesis. The issues of the complexity of diagnosing Crohn's disease in an atypical course (gastroduodenal form), the algorithm for selecting basic therapy for a severe course of the disease are considered. The second problem in the article is the tactics of managing patients with COVID-19 against the background of combined basic immunosuppressive therapy for autoimmune diseases. © 2022 Global Media Technologies. All rights reserved.

10.
Research and Practice in Thrombosis and Haemostasis Conference ; 6(Supplement 1), 2022.
Article in English | EMBASE | ID: covidwho-2128254

ABSTRACT

Background: Inflammatory bowel disease (IBD) including Crohn's disease (CD) and ulcerative colitis (UC), is associated with higher thrombotic risk and enhanced thrombin generation (TG) in adults. IBD patients were underrepresented in SARS-CoV- 2 mRNA vaccine trials. Case reports indicated that adverse events post-vaccination, including IBD flare, were more common among children, and those with prior COVID-19. Aim(s): To find out whether TG is increased in children with IBD as compared to healthy controls and whether TG parameters show significant changes following SARS-CoV- 2 mRNA vaccination. Method(s): In this observational case-control study, 37 children with IBD (CD:16, UC: 21) aged 12-18 years and 55 healthy age-matched children were enrolled. Blood was collected before and 2-4 weeks after the second dose of BNT162b2 (Pfizer-BioNTech) vaccine dose. Whole blood count, fibrinogen, inflammatory markers (CRP, ferritin), anti-SARS- CoV- 2 antibody levels were investigated, TG assay was carried-out using platelet-poor plasma. Lag time, endogen thrombin potential (ETP), peak thrombin, time-to- peak were calculated. Detailed clinical parameters including post-vaccination symptoms, COVID-19 history, disease activity scores (PUCAI, Mayo score, PCDAI) were registered. Result(s): CRP was significantly elevated in children with IBD and showed a positive correlation with ETP (CD: R = 0.700;p = 0.003 and CU: R = 0.501;p = 0.020). TG parameters did not differ between patients and controls pre-or post-vaccination. TG parameters remained unaltered post-vaccination in both groups. IBD disease flare was not observed post-vaccination, but reduced anti-SARS- CoV- 2 antibody titers were found in 4 patients receiving immunosuppressive therapies. Previous COVID-19 infection had no effect on TG levels. Conclusion(s): Although TG parameters correlated with the level of inflammation in children with IBD, the extent of TG was not significantly different from healthy controls. TG parameters and IBD disease activity scores did not increase significantly following mRNA vaccination. Our results support the safety of SARS-CoV- 2 mRNA vaccination in children with IBD, highlighting observations of lower antibody titers in immunosuppressed children.

11.
Annals of Neurology ; 92(Supplement 29):S142, 2022.
Article in English | EMBASE | ID: covidwho-2127551

ABSTRACT

Objective: To discuss neuro-immunologic complications of mRNA vaccinations. Background(s): Neuro-immunologic complications are a known risk of various types of vaccines, but little is known about complications after mRNA vaccines. Method(s): We present a series of four patients from a single institution who developed severe neurologic complications after mRNA COVID-19 vaccinations. Result(s): Case One: A 31-year-old female developed arm paresthesias, leg weakness and urinary retention one week following her first dose. MRI demonstrated T2 hyperintensity at T5 and T8-T9 with enhancement. She received five days methylprednisolone and IVIG. She remains wheelchair bound with urinary retention. Case Two: A 31-year-old male developed paresthesias in legs and urinary retention four weeks following his second dose. A year prior, he contracted COVID-19 and had transient leg paresthesias. MRI demonstrated T2 hyperintensity from lower medulla to the conus. He received five days of intravenous methylprednisolone followed by oral prednisone. He remains symptomatic requiring gabapentin, baclofen and tamsulosin. Case Three: A 75-year-old female with hypertension, diabetes mellitus and Crohn's disease developed leg weakness, complicated by respiratory failure, three days after her first dose. Guillian- Barre Syndrome was diagnosed based on nerve conduction studies. She received PLEX followed by IVIG. She can now ambulate with a walker. Case Four: A 59-year-old healthy female developed urinary retention, saddle anesthesia and leg weakness four weeks following her second dose. MRI spine demonstrated patchy T2 hyperintensities throughout the pons, C- and T-spine. She continues to have gait imbalance and urinary incontinence. Other causes of transverse myelitis including neuromyelitis optica and myelin oligodendrocyte associated disease were ruled out in Case 1, 2 and 4. CSF analysis in all were compatible with neuro-inflammation. Conclusion(s): These cases raise concern that mRNA vaccinations may be associated with neurologic complications due to heightened immune reactivity. Further studies are needed to understand the risk associated with mRNA vaccinations.

12.
Journal of the American Society of Nephrology ; 33:946, 2022.
Article in English | EMBASE | ID: covidwho-2125371

ABSTRACT

Introduction: IgA nephropathy (IgAN) is an immune complex glomerulonephritis (GN) characterized by glomerular deposition of IgA-dominant immune complexes, often accompanied by mesangial hypercellularity. Antineutrophil cytoplasmic antibodies (ANCAs) cause small-vessel vasculitis and pauci-immune crescentic GN. The coexistence of ANCAs and IgAN is quite rare. ANCAs have been associated with inflammatory bowel disease (IBD) but are more prevalent in ulcerative colitis (~75%) than Crohn's disease (~17%). IBD-associated ANCAs are usually p-ANCA or atypical ANCA rather than c-ANCA. ANCA-associated vasculitis (AAV) can be associated with tumor necrosis factor-alpha inhibitors such as infliximab. We report a rare case of c-ANCA PR3-positive IgAN in a patient with IBD treated with infliximab who presented with proteinuria. Case Description: A 27-year-old female with history of Crohn's disease since 2010 treated with infliximab, allergic rhinoconjunctivitis, mild asthma, erythema nodosum in June 2021 (resolved with prednisone), Charcot-Marie-Tooth disease, psoriasis, and COVID-19 disease in Oct 2021, was found to have positive c-ANCA (1:160) and PR3 (5.0 AI, reference <1.0) in Dec 2021, raising question of vasculitis. Her rhinosinusitis was well controlled with allergy medications without oral steroids. She was referred to Nephrology for proteinuria with urinalysis (UA) in April 2022 showing 2+ protein, 3+ blood, 2-10 WBC, 20-50 RBC. Urine protein/creatinine ratio was 1.9. She had foamy urine but no gross hematuria. She previously had UA with packed RBC in June 2021. Urogram showed non-specific bladder wall thickening. Cystourethroscopy was negative. In April 2022, her BP was 97/66 and she had no edema. A renal biopsy in May 2022 revealed IgAN (M0 E1 S1 T0 C0). She was started on lisinopril and fish oil. Discussion(s): This is a very rare case of c-ANCA PR3-positive IgAN in IBD treated with infliximab. The patient's history of sinusitis along with c-ANCA PR3 antibody positivity suggested possibly an AAV associated with infliximab, which has been reported rarely in IBD. Her proteinuria of 1.9 g/day raised concern for GN due to pauci-immune AAV. However, renal biopsy showed IgAN rather than AAV. This case highlights the importance of renal biopsy in establishing a definitive diagnosis of glomerular disorders in patients with ANCA positivity, as serum ANCAs do not necessarily represent pauciimmune GN.

13.
Science & Healthcare ; 24(4):12-18, 2022.
Article in English | GIM | ID: covidwho-2146478

ABSTRACT

Introduction. Coronavirus infection is an acute viral disease with a primary lesion of the upper respiratory tract, caused by an RNA-virus of the Betacoronavirus genus of the Coronaviridae family. The course of a viral infection varies from asymptomatic to a wide range of clinical manifestations, including fever, chills, gastrointestinal manifestations, pneumonia, respiratory distress, and death. Ulcerative colitis (UC) and Crohn's disease (CD) are chronic immune-mediated diseases with intestinal and systemic symptoms, which are based on an impairment of the intestinal microbiota and dysregulation of the immune system in genetically predisposed individuals. In the Kazakh population, risk factors also include irregular food intake (p=0.043;OR=3.61 [95% CI: 1.04-12.51]), consumption of fish and seafood (p=0.000;OR= 15.77 [95% CI: 4.56-54.59]), consumption of frozen processed foods (p = 0.018;OR = 4.62 [95% CI: 1.3-16.4]), diet based on meat dishes (p=0.029;OR=3.2 [95% CI: 1.13-9.2]), use of NSAIDs other than aspirin (p=0.031;OR=3.79 [1.13-12.69]) and smoking (p=0.008;OR=4.93 [95% CI: 1.52-15.98]) [26]. The suppression of the immune response is associated with the risk of infection with viral or bacterial pathogens, including potentially the SARS-CoV-2 virus. On the other hand, SARS-CoV-2 infection as a potential trigger factor for de novo occurrence of inflammatory bowel disease is currently being discussed [22, 25]. The aim of this study was to assess the characteristics of the course of COVID-19 during the treatment of inflammatory bowel diseases (IBD), risk factors and outcomes of COVID-19, as well as the activity of IBD before and after a coronavirus infection. Materials and methods. A longitudinal descriptive study included 158 patients with IBD who applied on an outpatient basis (including via remote consultation) or inpatient with SARS-Cov2 or COVID-19 infection in the academic centers of Almaty (Kazakhstan) n=54 and St. Petersburg (Russia), n= 104. The observation period was from May 2020 to May 2022. The median and interquartile range were used to describe quantitative data (age), and absolute frequencies and percentages were used for qualitative data. The Mann-Whitney U-test was used for intergroup comparison of quantitative data (age), for the remaining indicators, the likelihood ratio test (Likehood ratio test), and in the case of 2X2 tables, Fisher's exact test. Results. There was no association between IBD type/activity or drugs taken and the severity of COVID-19. However, the severity of COVID-19 affected the activity of IBD. We've identified the same risk factors for the development of a more severe course of COVID-19 were as in the world literature: cardiovascular pathology, arterial hypertension and chronic liver pathology. Conclusion. Thus, inflammatory bowel disease and current therapy do not affect the risk of SARS-Cov-2 infection and/or the severity of COVID-19, while infection associated with severe COVID-19 affects the activity or outcomes of IBD.

14.
United European Gastroenterology Journal ; 10(Supplement 8):739-740, 2022.
Article in English | EMBASE | ID: covidwho-2115381

ABSTRACT

Introduction: Vaccination is the most effective method to prevent and control the SARS-CoV-2 infection. Recommendations consider patients with inflammatory bowel disease (IBD), Crohn's disease (CD) and ulcerative colitis (UC), a high-priority population to COVID-19 vaccine administration. There were a lot of concerns about vaccination safety in the setting of biological and immunomodulatory drugs. The purpose of this study was to present data on safety about anti-SARSCoV- 2 vaccination in a cohort of IBD patients. These are data of an ongoing multicenter study assessing effectiveness and safety of COVID-19 vaccines in patients with IBD treated with immunomodulatory or biological drugs (ESCAPE-IBD) sponsored by the Italian Group for the study of Inflammatory Bowel Disease (IG-IBD - ClinicalTrials.gov Identifier: NCT04769258). Aims & Methods: Anti-SARS-CoV-2 vaccination was administrated to 809 IBD patients. Afterwards completed vaccination, telephone or in-person interviews were conducted from February to July 2021 by gastroenterologists from referral center to report local and/or systemic adverse events (AEs) related to vaccination. Data on medical history and treatment was collected from electronic health records. Of these 809, 346 patients were surveyed on the pandemic burden and the main reason for hesitancy in Covid-19 vaccination. Chi-square test was used to compare categorical variables. Logistic regression was used to assess the relationship between disease-related characteristics and the onset of AEs. Result(s): 809 patients, 456 CD and 353 UC, regularly followed in IBD unit, were enrolled. All patients received a complete SARS-CoV-2 vaccination cycle. Most of them (68%) were in biological or immunomodulatory therapy. About 45% of patients had at least one side effect, following the first dose (10%), the second (15%) or both doses (20%). Local pain at site of injection (24%), fatigue (33%) and fever (30%) were the three most common AEs. Flares of the underlying IBD were not reported. The vast majority of AE were mild and lasted only a few days. No serious AEs were reported and no patient was hospitalized. Logistic regression analysis revealed that female gender (p<0.001), younger age (p=0.001), seroconversion (p=0.002) and comorbidity (p<0.001) were significantly associated with the occurrence of AEs. Futhermore the survey showed that the pandemic did not affect IBD at all in 37.5%, and a lot in 9.2% of participants. The majority (95%) of patients welcomed the possibility of getting vaccinated;only 7% feared the vaccine's influence on the course of the IBD. The main concerns were the possibility of adverse effects (33%) and the failure to achieve immunity (17%), few for the type of vaccine (3%) and for the need to a further booster (6%). Almost all patients (99%) felt safer to have vaccinated at their IBD reference center. Conclusion(s): The short-term vaccine reactions experienced in this cohort of IBD patients were mostly self-limiting, including local pain at the injection site, fatigue and fever. We found a high acceptance rate and a good safety profile of SARS-CoV-2 vaccination in our cohort.

15.
United European Gastroenterology Journal ; 10(Supplement 8):745-746, 2022.
Article in English | EMBASE | ID: covidwho-2115239

ABSTRACT

Introduction: Coronavirus disease 2019 (COVID-19) and its consequences on individuals with inflammatory bowel diseases (IBD) are not yet fully understood despite the fact that evidence on this topic are rapidly evolving. Aims & Methods: This comprehensive study of clinical data aims to enhance the gastroenterologists' ability to manage inflammatory bowel disease during these Covid-19 pandemic dominated times. Until November 2021, a thorough search of PubMed and Embase for published data served as the primary source for the examined research, which was solely composed of English-language sources. Additionally, websites of gastroenterology societies and organizations dedicated to inflammatory bowel disease (IBD) were searched for consensus statements and recommendations for patients and clinicians (IBD). The information sources, the search strategy, and the eligibility criteria of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statements were followed Results: There are 1560 publications on this subject, including 30 randomized controlled trials, including 64,259 patients with inflammatory bowel disease (IBD). There are twenty-four studies (n = 51,920) that examined the effect of COVID 19 on inflammatory bowel disease (IBD) management. Crohn's disease affected 52.9% of patients, ulcerative colitis affected 42.0%, and indeterminate colitis affected 5.1%. These trials showed that the use of corticosteroids, azathioprine, or mesalamine was related to adverse outcomes, but the use of anti-TNFs was linked to improved outcomes. Seven randomized controlled trials evaluated the safety and efficacy of the COVID-19 vaccine in inflammatory bowel disease (IBD) patients and found that vaccination was extremely effective, with a seroconversion rate of 96.49% and no significant increase in adverse outcomes when compared to the general population. Conclusion(s): Patients with inflammatory bowel disease (IBD) are at an increased risk of severe COVID-19 infection. There is a substantial influence on the management of inflammatory bowel disease (IBD) patients during the pandemic, as certain IBD drugs have been connected with a worsening of outcomes. Although the COVID vaccine has been shown to be effective, additional research is needed to determine the long-term consequences of COVID 19 infection and vaccination.

16.
United European Gastroenterology Journal ; 10(Supplement 8):240, 2022.
Article in English | EMBASE | ID: covidwho-2115070

ABSTRACT

Introduction: Since 2020 COVID-19 pandemic has spread throughout the world and became an ongoing global health crisis due to SARS-CoV-2 virus. Elderly and pre-existing disorders including hypertension, heart problems, diabetes, cancer, autoimmune diseases and IBD are found associated with an increased risk of COVID-19. Although COVID-19 leads to mild flu-like symptoms in the majority of patients, the disease may cause severe complications and death. To date, a few clinical studies suggested that IBD and/or immunomodulation may reduce the susceptibility to COVID-19;however, the mechanisms through which this is happening is largely unknown. Aims & Methods: Aim of this study is to investigate the effects of IBD and different therapies on the risk of SARS-CoV-2 infection and COVID-19 severity through serum proteomics and metabolomics. Between April 2020 and April 2022, 238 IBD patients (N=145 Crohn disease, N=93 Ulcerative colitis) and 45 healthy controls (HC) of the North Italy area were enrolled and serum samples were collected. To evaluate the exposure to SARSCoV- 2, both clinical data were collected and seroprevalence of anti-SARSCoV- 2 Ab were analyzed by means of multiplex technology, the BioPlex 2200 Sars-Cov-2 IgG Panel (biorad, Italy). Serum samples underwent untargeted metabolomics analysis and the frequency of a serum metabolomics signature associated with protection were evaluated in IBD compared to HC and also between anti-TNF and Vedolizumab biological therapies for IBD patients. Result(s): The seroprevalence of anti-SARS-CoV-2 Ab in IBD cohort (22/238) indicates an overall lower incidence of COVID-19 in comparison with the general population of Lombardy. Our data indicated that IBD patients in treated with biologic drugs as anti-TNF (10,5%) and Vedolizumab (7,5%) have a lower incidence than IBD patients treated with conventional therapies (28,0%). Accordingly, we observed that serum metabolomics signature associated with protection was more frequent in IBD patients treated with anti-TNF (N=50, 70%), and with Vedolizumab (N=57, 85%) than healthy controls (N=45, 50%). The metabolomic protective profile is characterized by the presence of fat-soluble Tocopherols family members and Cholecalciferol and also of omega-3 and omega-6 polyunsaturated fatty acid. Conclusion(s): Our study indicates that IBD population treated with biologics has an overall lower risk to contract SARS-CoV-2 infection and a serum proteomic/metabolomic protection profile. The increased presence in IBD patients of radical scavengers such as tocopherols which are incorporated into cell membranes and protect against oxidative damage and anti-inflammatory and immunomodulating fatty acids suggest a better response to SARS-CoV-2 infection. Also increased levels of omega;-3 interfere with the entry of the virus by modulating the Lipid Rafts where ACE2 and TMPRSS2 are mainly expressed and PUFAs inhibit the attachment of SARS-CoV-2 virions to the human ACE2 receptor by interacting directly with the RBD sequence. Mechanistically understanding how this protection profile exerts its effects on COVID-19 severity might shed light on potential targets to increase resistance in higher risk subgroups of patients.

17.
United European Gastroenterology Journal ; 10(Supplement 8):242, 2022.
Article in English | EMBASE | ID: covidwho-2115069

ABSTRACT

Introduction: The current pandemia is due to the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) that was originally identified in China in 2019, when numerous cases of atypical pneumonia were reported. Elderly and pre-existing disorders including hypertension, heart problems, diabetes, cancer, autoimmune diseases and IBD are found associated with an increased risk of COVID-19. A few clinical studies suggested that IBD and immunomodulation may reduce the susceptibility to COVID-19;however, the molecular mechanisms are not fully revealed. Aims & Methods: In this study, we attempted to identify a transcriptomic signature as candidate of the effects of IBD and different therapies on the risk of SARS-CoV-2 infection and COVID-19 severity through colonic tissue gene expression. In 2020-2022, 192 IBD patients, 115 Crohn disease (CD), 77 Ulcerative colitis (UC) and 36 Healthy Controls (HC) of the North Italy area were enrolled. Colon biopsies from inflamed and non-inflamed mucosa were collected from IBD patients and healthy mucosa samples were collected from HC. To evaluate the exposure to SARS-CoV-2, clinical data were collected and seroprevalence of anti-SARS-CoV-2 Ab were analyzed by means of multiplex technology with BioPlex 2200 Sars-Cov-2 IgG Panel (biorad, Italy). Gene expression analysis of ACE2, TMPRSS2, TMPRSS4, ADAM17 were performed by qPCR in biopsies of the three experimental groups. Result(s): In IBD patients cohort the seroprevalence of anti-SARS-CoV-2 antibodies indicates an overall lower incidence of COVID-19 in comparison with the general population of Lombardy, and also a lower incidence in IBD patients in biological therapies vs. conventional ones. Gene expression analysis of the proteins involved in SARS-CoV-2 entry indicated that IBD patients treated with anti-TNF (N=72) had a lower mucosal level of SARS-CoV-2 receptor ACE2 and its sheddase ADAM17 than non-IBD subjects along with higher expression of the proteases TMPRSS2 and TMPRSS4. Moreover, vedolizumab-treated patients (N=40) showed a significant lower expression of ACE2, TMPRSS2 and TMPRSS4 than controls, whereas ADAM17 levels were similar. Conclusion(s): Data presented in our study suggest that the biologic-treated IBD population has an overall lower risk of contracting SARS-CoV-2 infection. Colonic expression of proteins involved in SARS-CoV-2 virus entry suggested an additional protective mechanism. Understanding the association of this protection profile with COVID-19 severity and the mechanisms of virus entry into the colon could reveal resistance pathways in higher-risk patient subgroups.

18.
United European Gastroenterology Journal ; 10(Supplement 8):241-242, 2022.
Article in English | EMBASE | ID: covidwho-2115016

ABSTRACT

Introduction: Paediatric Inflammatory Bowel Disease (pIBD) is a chronic disease that often requires immunosuppressive drugs such as glucocorticoids, thiopurines or biologic therapy, which may attenuate the response to certain vaccines. The SARS-CoV2 pandemic in 2020 prompted the rapid development of multiple vaccines and, although there are not many studies regarding their response in patients with IBD, it seems that there are differences in adults patients in relation to the treatment they receive. To the best of our knowledge, there is no literature on paediatric patients with IBD. In July 2021, vaccination against COVID 19 was authorised for adolescent patients from 12 years old. Aims & Methods: The aim of the present study is to assess the response to COVID-19 vaccination in pIBD patients. A prospective study was conducted in a tertiary hospital from July to December 2021 including pIBD patients from 12 to 18 years of age who agreed to be vaccinated. We determined baseline COVID-19 serostatus and analysed the serologic response after the complete vaccination regimen: 1 dose (patients with previous COVID- 19 infection) or 2 doses (those with no previous infection) of mRNA vaccine. During this period, three different immunoassay tests have been used for the semi-quantitative and qualitative determination of IgG antibodies against SARS-CoV2, which use different units of measurement and are not comparable with each other. We recorded clinical and epidemiological data. Statistical analysis was performed using SPSS software. Result(s): We included a total of 33 patients, 19 (56%) were male. The median age was 14.85 years (age range from 12 to 17.7). A total of 26 (79%) were diagnosed with Crohn's Disease, five (15%) with Ulcerative Colitis and two (6%) with unclassified IBD. Up to 23 patients (70%) were receiving biologic treatment and 20 (61%) had immunosuppressive treatment. Eight participants (24%) have undergone a COVID-19 infection, and in all cases reported mild or non-existent symptoms: seven of them (88%) were infected before the vaccination and only one (12%) after it. A total of 32 patients (97%) received the BioNTech/Pfizer vaccine (COMIRNATY) and one received MODERNA. Only five participants (15%) reported side effects after the vaccination, and these were in all cases mild (myalgia, headache, and low-grade fever, lasting less than 24 hours). Both the baseline and the post-vaccination serologic status were determined in 22 patients, and in seven patients only the post-vaccination status was carried out. All of them showed an adequate serologic response after the complete vaccination regimen. The development of adverse effects was independent of having suffered COVID-19 (p=0.17) and independent of treatment (p= 0.12). We found no statistical differences between patients receiving thiopurines or biologic treatment versus those without this kind of treatment (p=0.253 and p=0.521 respectively). Conclusion(s): The present preliminary study suggests that the pIBD population show an adequate response to the recommended vaccination regimen and the approved vaccines seem to be safe in this group of patients. Receiving thiopurines or biologictreatment did not seem to influence the serologic response. However, the small number of patients and the impossibility to compare antibody levels with different tests, limits the drawing of conclusions. Further studies are needed to stablish the duration and efficacy of the protective effect against COVID-19, and the potential need of a booster dose of the vaccine for pIBD patients.

19.
United European Gastroenterology Journal ; 10(Supplement 8):770-771, 2022.
Article in English | EMBASE | ID: covidwho-2115001

ABSTRACT

Introduction: Patients with Inflammatory Bowel Disease (IBD) frequently receive immunomodulating treatment, which may render them at increased risk of an attenuated immune response upon vaccination. In this study, we assessed the effects of different types of commonly prescribed immunosuppressive medications on the serological response after vaccination against SARS-CoV-2 in patients with IBD. Aims & Methods: In this prospective observational cohort study, IgG antibody titers against SARS-CoV-2 were measured 2-10 weeks after completion of standard vaccination regimens in patients with IBD. Clinical characteristics, previous history of SARS-CoV-2 infection, type of vaccine (mRNA- or vector-based) and medication use were recorded at the time of sampling. Subsequently, a chemiluminescent microparticle immunoassay was used for the quantitative determination of IgG antibodies against the receptor-binding domain (RBD) of the S1 subunit of the spike protein of SARS-CoV-2. Result(s): Three hundred and twelve (312) patients with IBD were included (172 Crohn's disease [CD] and 140 ulcerative colitis [UC]). Seroconversion (defined as titer of >50 AU/ml) was achieved in 98.3% of patients. Antibody concentrations were significantly lower in patients treated with TNF-alpha-antagonists vs. non-users of TNF-alpha-antagonists (geometric mean [95% confidence interval]: 2204 [1655-2935] vs. 5002 [4089-6116] AU/ml, P<0.001). In multivariable models, use of TNF-alpha-antagonists (P<0.001), vector vaccines (P<0.001), age (>50 years) (P<0.01) and CD (P<0.05) were independently associated with lower anti-SARS-CoV-2 antibody titers. In patients who received mRNA vaccines, users of thiopurines (either prescribed as monotherapy or in combination with biologicals) demonstrated significantly lower antibody titers compared to those who were thiopurine non-users (P<0.05). Conclusion(s): Despite reassuring findings that most patients with IBD have detectable antibodies after anti-SARS-CoV-2 vaccination, TNF-alpha- antagonists were found to be strongly associated with an attenuated IgG antibody response after vaccination against SARS-CoV-2, independent of vaccine type, the time elapsed after vaccination and blood sampling, prior SARS-CoV-2 infection and patient age. Patients treated with thiopurines and receiving mRNA-based vaccines demonstrated lower anti-SARS-CoV-2 antibody titers compared with non-users. This specific subgroup of patients treated with TNF-alpha-antagonists may benefit from active booster vaccine prioritization, preferably with mRNA-based vaccines.

20.
United European Gastroenterology Journal ; 10(Supplement 8):112-113, 2022.
Article in English | EMBASE | ID: covidwho-2114636

ABSTRACT

Introduction: The impact of COVID-19 has been of great concern in patients with inflammatory bowel disease (IBD) due to the possibility of increased risk of severe outcomes, which can result in increased hospital admission or increased mortality. Aims & Methods: This study aims to estimate the effect of IBD on mortality and the risk of hospitalizations in patients diagnosed with COVID-19. We included all COVID-19 patients in Croatia from the begging of the pandemic till the 15thof August 2021 and compared the COVID-19-related mortality and hospitalization risk in IBD patients vs general population and ulcerative colitis (UC) vs Crohn's disease (CD) patients. In all comparisons, patients were exactly matched on age, sex, vaccination status, time period of the pandemic, Charlson comorbidity index, important pharmacological therapy and relevant comorbidities. For sensitivity analysis, UC and CD patients were also matched using the optimal full + exact matching algorithm due to a smaller number of patients with the same set of covariates (except age was supplied as a continuous variable;and vaccination status, Charlson comorbidity index, and age binned to 10 years were supplied as exact covariates). Log-binomial regression with a robust sandwich variance estimator was used to calculate relative risk and 95% confidence intervals (RR and 95%CI) for outcomes (mortality and hospitalization). Result(s): We identified 3067 IBD patients among 433609 COVID-19 patients. Crude proportions of COVID-19-related mortality in unmatched data and calculated relative risk after matching indicated no difference in mortality of IBD and non-IBD patients [2.8% vs 2.7%, and RR = 0.85 (95%CI 0.60 - 1.19)]. On the other hand, the hospitalization rate was higher in IBD population both prior to matching (6.1% vs 4.5%) and after matching [RR = 1.43 (95%CI 1.17 - 1.75)]. Among 3067 IBD patients, we identified 2061 UC and 797 CD patients (for 209 patients IBD was unspecified). Unmatched comparison indicated an increased risk for COVID-19-related death (3.2% vs 1.8%) and hospitalization (6.1% and 5.8%) in patients suffering from UC. However, after matching using two different matching algorithms, we found no difference in mortality risk [RRprimary = 0.55 (95%CI 0.18 - 1.61), and RRsensitivity = 1.14 (95%CI 0.57 - 2.30)] nor hospitalization risk [RRprimary = 1.14 (95%CI 0.72 - 1.80) and RRsensitivity = 0.92 (95%CI 0.62 - 1.35)] between UC and CD. Conclusion(s): Our results indicate that IBD patients have a greater risk for hospitalization related to COVID-19 than the general population. On the other hand, COVID-19-related mortality risk is not increased in IBD patients, and no difference in COVID-19-related mortality and hospitalization was observed between UC and CD patients.

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