P150 INCREASED RISK OF IBD FLARE AFTER SARS-CoV-2 INFECTION. WHO’S THE MORE GUILTY: VIRAL INFECTION OR THERAPY WITHDRAWAL?
Bezzio, C.(1);Guarino, A.D.(1);Fiorino, G.(2);Armuzzi, A.(3);Ribaldone, D.G.(4);Furfaro, F.(5);Pugliese, D.(3);Vernero, M.(6);Variola, A.(7);Gerardi, V.(8);Scucchi, L.(9);Viganò, C.(10);Caprioli, F.A.(11);Roselli, J.(12);Coppini, F.(13);Ardizzone, S.(14);Onali, S.(15);Zingone, F.(16);Daperno, M.(17);Cortellezzi, C.(18);Carparelli, S.(19);Soriano, A.(20);Manes, G.(1);Saibeni, S.(1);
(1)Rho Hospital- ASST Rhodense, Gastroenterology Unit, Rho MI, Italy;(2)Humanitas University-, Department of Biomedical Sciences-, Milan, Italy;(3)Fondazione PoliclinicoUniversitarioGemelli IRCCS, CEMAD- IBD Unit- Internal Medicine and Gastroenterology Unit- Department of Medical and Surgical Sciences-, Rome, Italy;(4)Università di Torino, Division of Gastroenterology- Department of Medical Sciences-, Torino, Italy;(5)Humanitas University, Department of Biomedical Sciences-, Milan, Italy;(6)University of Pavia, Department of medical sciences- Gastroenterology unit, Santena, Italy;(7)IRCCS Sacro Cuore Don Calabria-, Gastroenterology Unit-, Verona, Italy;(8)Poliambulanza Foundation, Gastroenterology Unit-, Brescia, Italy;(9)University Tor Vergata, Department of Systems Medicine-, Rome, Italy;(10)San Gerardo Hospital, Gastroenterology Unit-, Monza, Italy;(11)Fondazione IRCCS Ca' GrandaOspedale Maggiore Policlinico, Gastroenterology and Endoscopy Unit-, Milan, Italy;(12)Azienda Ospedaliera Universitaria Careggi, Gastroenterology Unit, Firenze, Italy;(13)Azienda Ospedaliero Universitaria Pisana, Gastroenterology Unit-, Pisa, Italy;(14)ASST Fatebenefratelli Sacco, Gastroenterology Unit, Milan, Italy;(15)University of Cagliari, Department of Medical Science and Public Health- Gastroenterology Unit, cagliari, Italy;(16)University of Padua, Department of internal medicine-, Padua, Italy;(17)Mauriziano Hospital, 19Gastroenterology Unit, Turin, Italy;(18)Ospedale di Circolo e Fondazione Macchi, ASST Sette Laghi- Gastroenterology and GI Endoscopy Unit-, Varese, Italy;(19)Fondazione IRCCS Casa Sollievo della Sofferenza, Gastroenterology and Endoscopy Unit, San Giovanni Rotondo, Italy;(20)Azienda USL Arcispedale S. Maria Nuova - IRCCS di Reggio Emilia, GastroenterologyDivision-, Reggio Emilia, Italy; Italian Group for the study of InflammatoryBowelDisease (IG-IBD)
Background
In the last year, the severe adult respiratory syndrome coronavirus 2 (SARS-CoV-2) epidemic has spread rapidly around the world. The interactions between SARS-CoV-2 and inflammatory bowel disease (IBD) are so far not fully understood. In particular, no studies evaluated the potential role of SARS-CoV-2 on IBD course. Indeed, it is known that viral infections can be act as triggers for IBD flare and it is reasonable that the possible drug discontinuation during SARS-CoV-2 infection could in turn lead to an IBD flare.
Methods
This was a prospective, observational case-control study. From March 11th 2020 to June 30th 2020 we enrolled IBD patients with proven SARS-Cov-2 infection (“cases”) and IBD patients without SARS-CoV-2 infection matched for sex, age, diagnosis, therapy and clinical activity (“controls”). Cases and controls were followed-up at least for 6 months. Differences between case and control group were tested for significance using the Student’s t test and Fisher’s test, as appropriate. A two-tailed p value < 0.05 was indicative of statistical significance.
Results
219 IBD patients (127 UC, 58.0%) with SARS-CoV-2 infection and 219 IBD patients without SARS-CoV-2 infection were enrolled. Table 1 shows baseline features of the population. Among the 122 cases in clinical remission at the time of viral infection, 28 (22.9%) showed a disease flare; this percentage was significantly higher than that observed in controls: 12/137 (8.8%)( p=0.0018). Among patients with disease flare, there were no significant differences between cases and controls group in terms of age (42.3 ± 16.0 vs. 43.1 ± 15.4 years, p=0.44), gender (female 45.7% vs. 48.2%, p= 0.54), use of biologic therapies (p=0.83) and UC or CD diagnosis (p=0.06). Biologic therapy was temporary withdrawn more significantly in cases than in controls (68/202, 33.6% vs. 14/204, 6.9%) (p<0.001) and overall biologic therapy discontinuation was significantly associated with disease flare (OR 2.56, 95% CI 1.02-6.41, p=0.04).
Conclusion
IBD patients with SARS-CoV-2 infection have an increased risk to have a clinical recurrence in short-term in comparison with IBD patients without SARS-CoV-2 infection. This increased risk could be due to the viral infection and/or to the temporary discontinuation of biologic therapies, because of infection.