P140 Immunomodulators are protective against severe COVID 19: results from a large multicentre cohort of inflammatory bowel disease patients
Vuitton, L.(1);Bourrier, A.(2);Uzzan, M.(3);Nachury, M.(4);Amiot, A.(5);Roblin, X.(6);Allez, M.(7);Altwegg, R.(8);Vidon, M.(9);Bourreille, A.(10);Serrero, M.(11);Pelletier, A.L.(12);Filippi, J.(13);Gilletta, C.(14);Simon, M.(15);Laharie, D.(16);Nahon, S.(17);Duveau, N.(18);Biron, A.(19);Viennot, S.(20);Abitbol, V.(21);Elgharabawy, Y.(22);Peyrin-Biroulet, L.(23);
(1)Besançon University Hospital- Franche-Comté University- UMR 1098, Department of Gastroenterology, Besançon, France;(2)Saint Antoine University Hospital- Assistance Publique-Hôpitaux de Paris APHP, Gastroenterology, Paris, France;(3)Beaujon University Hospital- APHP, Gastroenterology, Clichy, France;(4)Lille University hospital, HepatoGastroenterology, Lille, France;(5)Mondor University Hospital- APHP, Hepatogastroenterology, Creteil, France;(6)St-Etienne university hospital, Hepatogastroenterology, Saint-Etienne, France;(7)Saint-Louis university hospital- APHP, Gastroenterology, Paris, France;(8)Montpellier university hospital, Hepatogastroenterology, Montpellier, France;(9)Centre Hospitalier Intercommunal de Créteil, HepatoGastroenterology, Créteil, France;(10)Nantes university Hospital, Hepatogastroenterology, Nantes, France;(11)Hôpital Nord de Marseille- APHM, Gastroenterology, Marseille, France;(12)Bichat hospital- APHP, Gastroenterology, Paris, France;(13)Nice University hospital, Gastroenterology, Nice, France;(14)Toulouse university hospital, Hepatogastroenterology, Toulouse, France;(15)IMM hospital, Gastroenterology, Paris, France;(16)Bordeaux university hospital, Hepatogastroenterology, Bordeaux, France;(17)Montfermeil hospital, Hepatogastroenterology, Montfermeil, France;(18)Roubaix hospital, Hepatogastroenterology, Roubaix, France;(19)Reims university hospital, Hepatogastroenterology, Reims, France;(20)Caen university hospital, Hepatogastroenterology, Caen, France;(21)Cochin university hospital- APHP, Gastroenterology, Paris, France;(22)GETAID, Methodology, Paris, France;(23)Nancy university hospital, Hepatogastroenterology, Nancy, France; GETAID COVID study group
Background
In the context of the Sars-Cov2 pandemic, the management of patients with chronic diseases and/or receiving immunosuppressive drugs was of concern due to lack of data to dictate their management. The objectives of our study were to evaluate the characteristics and prognosis of COVID-19 among IBD patients and to study the factors associated with severe COVID-19.
Methods
We carried out a multicentre bispective study in 30 French GETAID centres. Participating centres were asked to report all consecutive COVID19 cases occurring in their IBD-cohort between March,1st and December,31st 2020. The cases had to be confirmed by a PCR test, or by a chest CT scan demonstrating COVID19 lesions. In addition to the baseline examination, patients were scheduled for a follow up visit within 3-6 months following their infection. Demographics, disease characteristics, treatments, and the clinical course of IBD were prospectively recorded. Severe COVID-19 was defined as admission to the hospital >1 day and/or use of oxygen therapy and/or death. Predictive factors for developing severe COVID-19 were explored using univariate and multivariate logistic regression.
Results
A total of 719 IBD patients with COVID 19 were included; 54.2% were women, median age was 42 years, 64.4% had Crohn's disease (CD), and median disease duration was 10.8 years. 13.3% of the patients were active smokers;12.7% had a BMI>30. With respect to the treatment, 72(10%) patients were not on any IBD medication, 75(10.4%) were only receiving 5-ASA, 164(22.8%) received conventional immunosuppressants, and 509(70.8%) biologics.21.6% of the patients developed either diarrhoea in remitters, or an exacerbation of diarrhoea in active patients. IBD treatments were maintained unchanged, suspended or discontinued in 73.4%, 25.5%, and 1.1% of the patients. Over the follow-up period, 13.2% of the patients had a flare. A total of 68 patients developed severe COVID 19, 67(9.3%) were hospitalized for a median duration of 6 days, and 4(0.6%) patients died. In multivariate analysis, age > 50 years (OR: 2.0,CI:1.06-3.72; p=0.031), obesity (OR: 2.01,CI:1.05-4.09; p=0.037), and comorbidities (OR: 3.28,CI:1.76-6.09; p=0.0002) were factors associated with the occurrence of severe COVID 19; while immunomodulatory treatment (biologic and/or immunosuppressant) was a protective factor for developing severe COVID 19 (OR: 0.38,CI: 0.22-0.69; p=0.0012).
Conclusion
Rate of severe COVID 19 in this cohort of IBD patients was corresponding to the general population with similar risk factors for severity, i.e., age, obesity and comorbidities. Prescription of immunomodulators was protective against severe COVID 19, raising the hypothesis of their potential immunological effect on the immune storm phase of Sars-Cov2.