HOSPITALIZATION FOR DRUG INFUSION DOES NOT INCREASE COVID INFECTION RATE, IBD RELAPSES DUE TO INFECTIONS AND LEVELS OF ANXIETY IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE: A COMPARATIVE STUDY

ABSTRACT

Background and aim: During coronavirus disease 2019 (COVID-19) pandemic, immumodulatory therapies as well as the access to high-risk places (i.e. hospitals, infusion centers) were associated to an increased risk of infection. Nevertheless, patients with inflammatory bowel diseases (IBD) treated with intravenous (i.v.) biologics had to move to hospital for drug infusion, in contrast to patients treated with subcutaneous (s.c.) therapies who could remain at home, monitored through telemedicine. We investigated whether patients hospitalized or treated at home showed similar COVID-19 risk, as well as the levels of anxiety in both groups Materials and methods: We conducted a survey including consecutive IBD patients in clinical and biochemical remission treated with biologics referring to the lockdown period. Patients underwent the normally scheduled clinical visits, performed at home by means of telemedicine for patients treated with s.c. drugs and only in specific cases for patients treated with i.v. therapies. We administered to all patients the Hospital Anxiety and Depression Scale (HADS) questionnaire and other 12 questions, specifically related to COVID and its implications. Group differences in continuous and nominal variables were tested by Kruskal–Wallis test and Fisher exact test, respectively Results: A total of 189 IBD patients were recruited, 112 (59.3%) treated with i.v. drugs and 77 (40.7%) with s.c. ones. No augmented risk of COVID infection were recorded in both groups (hospitalized vs. non-hospitalized, p=ns). The two groups of patients had similar scores in the 14 single items of the HADS questionnaire (p>0.10 for all). The total HADS score obtained by the sum of all items was also almost identical between groups (37.1±2.8 vs 37.2±2.8;p=0.98). In patients treated with i.v. drugs receiving a televisit (n=17), the rates of satisfaction about telemedicine (58.8%) and the lack of in-person care (33.3%) were significantly lower compared with those treated with s.c. drugs (94.8% and 92.2%, respectively;both p<0.0005). Conclusions: Our results suggest that there is no need to convert patients from i.v. to s.c. therapy during COVID-19 outbreaks, since the risk of infection and its transmission is not increased. Moreover, anxiety levels are similar in both groups, emphasizing that hospitalization seems not affecting the psychological status of the patients and therefore not increasing the relapse rate.