OBJECTIVE: Our aim was to explore the risk of infection with all classes of inflammatory bowel disease (IBD) medications and the impact of these medications on the disease course in a nationwide cohort of patients with IBD .
DESIGN: This was a retrospective national cohort study of patients with IBD in the Veterans Affairs Healthcare System . We categorised IBD medication use immediately prior to the COVID-19 pandemic and used survival analysis methods to study associations with SARS-CoV-2 infection, as well as a combined secondary outcome of COVID-19 hospitalisation or COVID-19-related mortality .
RESULTS: The analytical cohort of 30 911 patients was primarily male (90.9 %), white (78.6 %) and with ulcerative colitis (58.8 %). Over a median follow-up of 10.7 months , 649 patients (2.1 %) were diagnosed with SARS-CoV-2 infection and 149 (0.5 %) met the combined secondary outcome . In adjusted models, vedolizumab (VDZ) use was significantly associated with infection relative to mesalazine alone (HR 1.70 , 95% CI 1.16 to 2.48, p=0.006). Patients on no IBD medications had increased risk of the combined secondary outcome relative to mesalazine alone (sub-HR 1.64 , 95% CI 1.12 to 2.42, p=0.01), however, no other IBD medication categories were significantly associated with this outcome, relative to mesalazine alone (each p> 0.05). Corticosteroid use was independently associated with both SARS-CoV-2 infection (HR 1.60 , 95% CI 1.23 to 2.09, p=0.001) and the combined secondary outcome (sub-HR 1.90 , 95% CI 1.14 to 3.17, p=0.01).
CONCLUSION: VDZ and corticosteroid were associated with an increased risk of SARS-CoV-2 infection . Except for corticosteroids no medications including mesalazine were associated with an increased risk of severe COVID-19.
Index: 5-aminosalicylic acid (5-ASA), COVID-19, crohn's disease, inflammatory bowel disease, ulcerative colitis