COVID-19 and Outcomes in Patients With Inflammatory Bowel Disease: Systematic Review and Meta-Analysis

被引:48
作者
Tripathi, Kartikeya [1 ]
Godoy Brewer, Gala [2 ]
Thu Nguyen, Minh [3 ]
Singh, Yuvaraj [4 ]
Saleh Ismail, Mohamed
Sauk, Jenny S. [3 ]
Parian, Alyssa M. [2 ]
Limketkai, Berkeley N. [3 ]
机构
[1] Univ Massachusetts, Sch Med, Baystate Campus, Springfield, MA USA
[2] Johns Hopkins Univ, Sch Med, Div Gastroenterol & Hepatol, Baltimore, MD USA
[3] UCLA Sch Med, Vatche & Tamar Manoukian Div Digest Dis, Los Angeles, CA USA
[4] St Vincent Hosp, Worcester, MA 01604 USA
关键词
COVID-19; IBD; UC; CD; antitumor necrosis factors; SEVERE ULCERATIVE-COLITIS; CROHNS-DISEASE; SARS-COV-2; INFECTION; CLINICAL CHARACTERISTICS; SINGLE-CENTER; RISK; MANAGEMENT; IBD; SEVERITY; THERAPY;
D O I
10.1093/ibd/izab236
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Background Our understanding of coronavirus disease 2019 (COVID-19) and its implications for patients with inflammatory bowel diseases (IBD) is rapidly evolving. We performed a systematic review and meta-analysis to investigate the epidemiology, clinical characteristics, and outcomes in IBD patients with COVID-19. Methods We searched PubMed, EMBASE, Cochrane Central, Clinicaltrials.gov, Web of Science, MedRxiv, and Google Scholar from inception through October 2020. We included studies with IBD patients and confirmed COVID-19. Data were collected on the prevalence, patient characteristics, pre-infection treatments for IBD, comorbidities, hospitalization, intensive care unit (ICU), admission, and death. Results Twenty-three studies with 51,643 IBD patients and 1449 with COVID-19 met our inclusion criteria. In 14 studies (n = 50,706) that included IBD patients with and without COVID-19, the prevalence of infection was 1.01% (95% confidence interval [CI], 0.92-1.10). Of IBD patients with COVID-19, 52.7% had Crohn's disease, 42.2% had ulcerative colitis, and 5.1% had indeterminate colitis. Nine studies (n = 687) reported outcomes according to IBD therapy received. Compared with patients on corticosteroids, those on antitumor necrosis factor (anti-TNF) therapy had a lower risk of hospitalization (risk ratio [RR], 0.24; 95% CI, 0.16-0.35; P < .01; I-2 = 0%) and ICU admission (RR, 0.10; 95% CI, 0.03-0.37; P < .01) but not death (RR, 0.16; 95% CI, 0.02-1.71; P = .13; I-2 = 39%). Compared with patients on mesalamine, those on antitumor necrosis factor therapy had a lower risk of hospitalizations (RR, 0.37; 95% CI, 0.25-0.54), ICU admissions (RR, 0.20; 95% CI, 0.07-0.58), and death (0.21; 95% CI, 0.04-1.00). Comparing patients on immunomodulators vs mesalamine or anti-TNF therapy, there was no difference in these outcomes. Conclusions The prevalence of COVID-19 in IBD patients was low. Use of corticosteroids or mesalamine was significantly associated with worse outcomes, whereas use of anti-TNFs was associated with more favorable outcomes. Further investigation clarifying the mechanisms of these disparate observations could help identify risk and adverse outcome-mitigating strategies for patients with IBD.
引用
收藏
页码:1265 / 1279
页数:15
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