INTERIM ANALYSIS OF A MULTICENTER REGISTRY STUDY OF COVID-19 INFECTED PATIENTS WITH INFLAMMATORY BOWEL DISEASE IN JAPAN (J-COSMOS)

ABSTRACT

Background: The spread of COVID-19 has had a major impact on the health of people worldwide. The clinical background and clinical course of Japanese inflammatory bowel disease (IBD) patients with COVID-19 remains unclear. Patients with IBD are often on immunosuppressive therapy, and there has been concern about the severity of COVID-19. We conducted the multicenter registry study of Japanese patients with inflammatory bowel disease with COVID-19. Methods: This study is an observational cohort of Japanese IBD patients diagnosed with COVID-19, and was registered in the UMIN Clinical Trials Registry (ID UMIN000040656). Data on age, gender, IBD (classification, treatment, and activity), COVID-19 symptoms and severity, and treatment of COVID-19 were analyzed. Results: From 72 facilities in Japan, one hundred eighty-seven patients were registered from June 2020 to October 2021 (Table1). The estimated incidence ratio of COVID19 in Japanese IBD patients was 0.61%. The median age (±SD) was 42.0±15.6, 4.8% of patients were obese with BMI >30, 7.0% were current smokers, and 31.0% had some complications. Of the patients enrolled, 104 had ulcerative colitis, 74 had Crohn's disease, 3 had IBD-Unclassified, and 6 had intestinal Behcet's disease. The majority of IBD patients with COVID-19 (73%) were in clinical remission. COVID-19 cases were most common in the 20-50 age group, but the COVID-19 severity rate according to WHO classification tended to be higher in the elderly than in middle-aged persons (Figure1). In Japan, the second SARS-CoV-2 vaccination rate jumped from 0% to 90% in just four months from May to September 2021 because the elderly received vaccination preferentially. Therefore, during the fifth wave of the epidemic (July-September 2021), infections among elderly IBD patients were particularly low compared with the younger. According to WHO classification regarding COVID-19 severity, 172 patients (92%) had non-severe, 12 (6%) were severe including serious conditions. Most IBD patients (UC and CD) with COVID-19 had no change in disease activity. A logistic regression analysis stepwise method revealed that older age, higher BMI, and steroid use were risk factors for COVID-19 severity. Six of eight patients who had COVID-19 after vaccination were receiving anti-TNF-alpha antibodies. Conclusion: The estimated incidence ratio of COVID19 in Japanese IBD patients was 0.61%. Age, BMI, and steroid use were associated with COVID-19 severity in Japanese IBD patients. (Table Presented) Table1. Case profile of the registered patients (Figure Presented) Figure1. The Age distribution of patients with COVID-19 and the COVID-19 severity rate