About IBD - Understanding IBD During COVID-19

Crohn’s & Colitis Congress: Understanding IBD During COVID-19

Crohn’s & Colitis Congress is a meeting focused on inflammatory bowel disease (IBD) that’s organized by the American Gastroenterological Association and the Crohn’s & Colitis Foundation. The meeting is geared towards healthcare providers who want to learn more about treating patients who live with IBD.

Ryan Ungaro, MS, MD, Assistant Professor of Medicine (Gastroenterology) at Icahn School of Medicine at Mount Sinai, gave a presentation at Crohn’s & Colitis Congress entitled “Understanding IBD-Related Care in the Era of COVID-19.”


 Quick Takes
  • IBD doesn’t increase the risk of developing COVID-19
  • Most IBD medications should be continued during the pandemic
  • IBD patients should receive the COVID-19 vaccination

The presentations range from studies being done on mice to case reports to advice on how to mange IBD patients day-to-day. Crohn’s & Colitis Congress also works towards including the patient voice and experience, with IBD patients being part of panels, alongside IBDologists, psychologists, dietitians, and other subject matter experts.

This year the meeting was held virtually and presenters and participants took part from their homes, their offices, and their living rooms (and for one notable IBDologist, from atop an exercise bike!). The 4 day event was still packed with sessions and multiple tracks of content, aimed at helping providers in all areas of healthcare better understand IBD.

As a journalist in the IBD space, I was invited to attend Congress in order to bring learnings back to patients, as well as to keep up with the latest research and trends in IBD.

As expected, the COVID-19 pandemic was superimposed over many of the presentations for 2021. After all, SARS-CoV-2 has broad implications for every aspect of IBD including how patients receive care, if treatments for Crohn’s disease or ulcerative colitis affect the development of COVID-19, and the questions surrounding the messenger RNA vaccines.

In the spring of 2020, researchers from Mount Sinai and the University of North Carolina set up the international Surveillance Epidemiology of Coronavirus Under Research Exclusion (SECURE)-IBD database. The purpose was to collect data about people living with IBD who then developed COVID-19. Healthcare providers were asked to enter data about their patients into the database, which included information such as age, ethnicity, IBD diagnosis, comorbidities (other conditions), and which medications they are receiving. To date, over 4.5k cases of COVID-19 in patients with IBD have been reported. Dr Ungaro’s talk included an in-depth look at the outcomes from this database.

Some of the broad takeaways include:

  • Patients should speak with their healthcare team about their specific risk in regards to COVID-19 and vaccination
  • People with IBD don’t appear to be at an increased risk of contracting COVID-19
  • There may be a slight risk of adverse events in IBD patients who develop COVID-19, but this was mostly seen in those who:
    • Are older
    • Have other health conditions
    • Are receiving steroids (such as prednisone)
  • There’s a possibility of an increased risk of complications in patients receiving thiopurines (which includes azathioprine, 6-mercaptopurine) or combination therapy (more than one drug to treat IBD)
  • Decisions about how to treat COVID-19 should be made on a case-by-case basis for patients with IBD
  • In some cases, there might be reason to consider tapering down the dosage of steroids or de-escalate (decrease) the use of combination therapy
  • For patients who have IBD that is difficult to treat, there might be a need to continue biologics during COVID-19
  • Vaccination against COVID-19 is recommended for all people who live with IBD

For people who live with IBD, this largely appears to be good news. At the start of the pandemic there was widespread concern that people with IBD would be at increased risk for contracting and having complications from COVID-19, and so far the data doesn’t show that to be the case. As Dr Ungaro stated during his presentation, “…the prevalence of COVID-19 was no different in IBD patients compared to controls. So [it is] reassuring that it does not appear that IBD patients are at increased risk of getting COVID-19.”

Now that vaccines are becoming available, it’s also recommended that people with IBD get vaccinated whenever the opportunity arises. More studies on what the immune response is for people with IBD and how it compares to healthy people are coming. However, that doesn’t change the recommendation because even if the vaccines are found to be less effective in certain groups, some protection is still better than none.

Sources:
Brenner EJ, Ungaro RC, Colombel JF, Kappelman MD. SECURE-IBD Database Public Data Update. covidibd.org. Accessed on 01/27/2021.

Ungaro RC. Understanding IBD-Related Care in the Era of COVID-19. Oral presentation at: Crohn’s & Colitis Congress; January, 2021.

Mount Sinai. What Should Gastroenterologists and Patients Know About COVID-19? Icahn School of Medicine at Mount Sinai. March 26, 2020. Available at: https://health.mountsinai.org/blog/what-should-gastroenterologists-and-patients-know-about-covid-19/

Other Resources:
Aziz M, Fatima R, Haghbin H, Lee-Smith W, Nawras A. The Incidence and Outcomes of COVID-19 in IBD Patients: A Rapid Review and Meta-analysis. Inflamm Bowel Dis. 2020;26:e132-e133. doi:10.1093/ibd/izaa170.

Bezzio C, Saibeni S, Variola A, et al; Italian Group for the Study of Inflammatory Bowel Disease (IG-IBD). Outcomes of COVID-19 in 79 patients with IBD in Italy: an IG-IBD study. Gut. 2020;69:1213-1217. doi: 10.1136/gutjnl-2020-321411.

Brenner EJ, Ungaro RC, Gearry RB, et al. Corticosteroids, But Not TNF Antagonists, Are Associated With Adverse COVID-19 Outcomes in Patients With Inflammatory Bowel Diseases: Results From an International Registry. Gastroenterology. 2020;159:481-491.e3. doi: 10.1053/j.gastro.2020.05.032.

Khan N, Patel D, Xie D, Pernes T, Lewis J, Yang YX. Are Patients With Inflammatory Bowel Disease at an Increased Risk of Developing SARS-CoV-2 than Patients Without Inflammatory Bowel Disease? Results From a Nationwide Veterans’ Affairs Cohort Study. Am J Gastroenterol. 2020 Oct 19. doi: 10.14309/ajg.0000000000001012.

Singh S, Khan A, Chowdhry M, Bilal M, Kochhar GS, Clarke K. Risk of Severe Coronavirus Disease 2019 in Patients With Inflammatory Bowel Disease in the United States: A Multicenter Research Network Study. Gastroenterology. 2020;159:1575-1578.e4. doi: 10.1053/j.gastro.2020.06.003.

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