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Treatment adaptations and outcomes of patients experiencing inflammatory bowel disease flares during the early COVID-19 pandemic: the PREPARE-IBD multicentre cohort study.
Saifuddin, Aamir; Kent, Alexandra J; Mehta, Shameer J; Hicks, Lucy C; Gonzalez, Haidee A; Segal, Jonathan P; Brookes, Matthew J; Subramanian, Sreedhar; Bhala, Neeraj; Conley, Thomas E; Patel, Kamal V; Lamb, Christopher A; Walker, Gareth J; Kennedy, Nicholas A; Sebastian, Shaji.
  • Saifuddin A; London North West University Healthcare NHS Trust, London, UK.
  • Kent AJ; Department of Gastroenterology, King's College Hospital NHS Foundation Trust, London, UK.
  • Mehta SJ; Department of Gastroenterology, Barts Health NHS Trust, London, UK.
  • Hicks LC; Department of Gastroenterology, Imperial College Healthcare NHS Trust, London, UK.
  • Gonzalez HA; Department of Inflammatory Bowel Disease, Hull University Teaching Hospitals NHS Trust, Hull, UK.
  • Segal JP; Department of Gastroenterology, University of Hull, Hull, UK.
  • Brookes MJ; Department of Gastroenterology, Imperial College Healthcare NHS Trust, London, UK.
  • Subramanian S; Department of Gastroenterology, Royal Wolverhampton NHS Trust, Wolverhampton, UK.
  • Bhala N; Faculty of Science and Engineering, University of Wolverhampton, Wolverhampton, UK.
  • Conley TE; Department of Gastroenterology, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK.
  • Patel KV; Department of Gastroenterology, University of Liverpool, Liverpool, UK.
  • Lamb CA; Institute of Applied Health Research, Institute of Translational Medicine, University of Birmingham, Birmingham, UK.
  • Walker GJ; Department of Gastroenterology, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK.
  • Kennedy NA; Department of Gastroenterology, St George's University Hospitals NHS Foundation Trust, London, UK.
Aliment Pharmacol Ther ; 56(10): 1460-1474, 2022 Nov.
Article in English | MEDLINE | ID: covidwho-2052261
ABSTRACT

BACKGROUND:

The COVID-19 pandemic offered a unique opportunity to understand inflammatory bowel disease (IBD) management during unexpected disruption. This could help to guide practice overall.

AIMS:

To compare prescribing behaviour for IBD flares and outcomes during the early pandemic with pre-pandemic findings

METHODS:

We performed an observational cohort study comprising patients who contacted IBD teams for symptomatic flares between March and June 2020 in 60 National Health Service trusts in the United Kingdom. Data were compared with a pre-pandemic cohort after propensity-matching for age and physician global assessment of disease activity.

RESULTS:

We included 1864 patients in each of the pandemic and pre-pandemic cohorts. The principal findings were reduced systemic corticosteroid prescription during the pandemic in Crohn's disease (prednisolone pandemic 26.5% vs. 37.1%; p < 0.001) and ulcerative colitis (UC) (prednisolone pandemic 33.5% vs. 40.7%, p < 0.001), with increases in poorly bioavailable oral corticosteroids in Crohn's (pandemic 15.6% vs. 6.8%; p < 0.001) and UC (pandemic 11.8% vs. 5.2%; p < 0.001). Ustekinumab (Crohn's and UC) and vedolizumab (UC) treatment also significantly increased. Three-month steroid-free remission in each period was similar in Crohn's (pandemic 28.4% vs. 32.1%; p = 0.17) and UC (pandemic 36.4% vs. 40.2%; p = 0.095). Patients experiencing a flare and suspected COVID-19 were more likely to have moderately-to-severely active disease at 3 months than those with a flare alone.

CONCLUSIONS:

Despite treatment adaptations during the pandemic, steroid-free outcomes were comparable with pre-pandemic levels, although concurrent flare and suspected COVID-19 caused worse outcomes. These findings have implications for IBD management during future pandemics and for standard practice.
Subject(s)

Full text: Available Collection: International databases Database: MEDLINE Main subject: Inflammatory Bowel Diseases / Colitis, Ulcerative / Crohn Disease / COVID-19 Type of study: Cohort study / Diagnostic study / Observational study / Prognostic study Topics: Long Covid Limits: Humans Language: English Journal: Aliment Pharmacol Ther Journal subject: Pharmacology / Gastroenterology / Drug Therapy Year: 2022 Document Type: Article Affiliation country: Apt.17223

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Inflammatory Bowel Diseases / Colitis, Ulcerative / Crohn Disease / COVID-19 Type of study: Cohort study / Diagnostic study / Observational study / Prognostic study Topics: Long Covid Limits: Humans Language: English Journal: Aliment Pharmacol Ther Journal subject: Pharmacology / Gastroenterology / Drug Therapy Year: 2022 Document Type: Article Affiliation country: Apt.17223