COVID-19 in Patients with Inflammatory Bowel Disease: The Israeli Experience

Lev Lichtenstein; Benjamin Koslowsky; Ami Ben Ya’acov; Irit Avni-Biron; Baruch Ovadia; Ofer Ben-Bassat; Timna Naftali; Uri Kopylov; Yael Haberman; Hagar Banai Eran; Rami Eliakim; Adi Lahat-Zok; Ayal Hirsch; Eran Zittan; Nitsan Maharshak; Matti Waterman; Eran Israeli; Idan Goren; Jacob E. Ollech; Henit Yanai; Bella Ungar; Benjamin Avidan; Dana Ben Hur; Bernardo Melamud; Ori Segol; Zippora Shalem; Iris Dotan; Selwyn H. Odes; Shomron Ben-Horin; Yf’At Snir; Yael Milgrom; Efrat Broide; Eran Goldin; Yulia Ron; Nathaniel Aviv Cohen; Eran Maoz; Maya Zborovsky; Safwat Odeh; Naim Abu Freha; Eyal Shachar; Yehuda Chowers; Tal Engel; Hila Reiss-Mintz; Arie Segal; Adar Zinger; Ariella Bar Gil Shitrit; Shmuel Delgado

doi:10.3390/vaccines10030376

COVID-19 in Patients with Inflammatory Bowel Disease: The Israeli Experience

Lev Lichtenstein, Benjamin Koslowsky, Ami Ben Ya’acov, Irit Avni-Biron, Baruch Ovadia, Ofer Ben-Bassat, Timna Naftali, Uri Kopylov, Yael Haberman, Hagar Banai Eran, Rami Eliakim, Adi Lahat-Zok, Ayal Hirsch, Eran Zittan, Nitsan Maharshak, Matti Waterman, Eran Israeli, Idan Goren, Jacob E. Ollech, Henit YanaiBella Ungar, Benjamin Avidan, Dana Ben Hur, Bernardo Melamud, Ori Segol, Zippora Shalem, Iris Dotan, Selwyn H. Odes, Shomron Ben-Horin, Yf’At Snir, Yael Milgrom, Efrat Broide, Eran Goldin, Yulia Ron, Nathaniel Aviv Cohen, Eran Maoz, Maya Zborovsky, Safwat Odeh, Naim Abu Freha, Eyal Shachar, Yehuda Chowers, Tal Engel, Hila Reiss-Mintz, Arie Segal, Adar Zinger, Ariella Bar Gil Shitrit, Shmuel Delgado

Research output: Contribution to journal › Article › peer-review

Abstract

Background: Crohn’s disease (CD) and ulcerative colitis (UC) are chronic, immune-mediated inflammatory bowel diseases (IBD) affecting millions of people worldwide. IBD therapies, designed for continuous immune suppression, often render patients more susceptible to infections. The effect of the immune suppression on the risk of coronavirus disease-19 (COVID-19) is not fully determined yet. Objective: To describe COVID-19 characteristics and outcomes and to evaluate the association between IBD phenotypes, infection outcomes and immunomodulatory therapies. Methods: In this multi-center study, we prospectively followed IBD patients with proven COVID-19. De-identified data from medical charts were collected including age, gender, IBD type, IBD clinical activity, IBD treatments, comorbidities, symptoms and outcomes of COVID-19. A multivariable regression model was used to examine the effect of immunosuppressant drugs on the risk of infection by COVID-19 and the outcomes. Results: Of 144 IBD patients, 104 (72%) were CD and 40 (28%) were UC. Mean age was 32.2 ± 12.6 years. No mortalities were reported. In total, 94 patients (65.3%) received biologic therapy. Of them, 51 (54%) at escalated doses, 10 (11%) in combination with immunomodulators and 9 (10%) with concomitant corticosteroids. Disease location, behavior and activity did not correlate with the severity of COVID-19. Biologics as monotherapy or with immunomodulators or corticosteroids were not associated with more severe infection. On the contrary, patients receiving biologics had significantly milder infection course (p = 0.001) and were less likely to be hospitalized (p = 0.001). Treatment was postponed in 34.7% of patients until recovery from COVID-19, without consequent exacerbation. Conclusion: We did not witness aggravated COVID-19 outcomes in patients with IBD. Patients treated with biologics had a favorable outcome.

Original language	English
Article number	376
Journal	Vaccines
Volume	10
Issue number	3
DOIs	https://doi.org/10.3390/vaccines10030376
State	Published - 28 Feb 2022
Externally published	Yes

Bibliographical note

Publisher Copyright:
© 2022 by the authors. Licensee MDPI, Basel, Switzerland.

Keywords

Biological drugs
COVID-19
Crohn’s disease
Immune suppression
Inflammatory bowel disease
Ulcerative colitis

ASJC Scopus subject areas

Immunology
Pharmacology
Drug Discovery
Infectious Diseases
Pharmacology (medical)

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10.3390/vaccines10030376

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Lichtenstein, L., Koslowsky, B., Ya’acov, A. B., Avni-Biron, I., Ovadia, B., Ben-Bassat, O., Naftali, T., Kopylov, U., Haberman, Y., Eran, H. B., Eliakim, R., Lahat-Zok, A., Hirsch, A., Zittan, E., Maharshak, N., Waterman, M., Israeli, E., Goren, I., Ollech, J. E., ... Delgado, S. (2022). COVID-19 in Patients with Inflammatory Bowel Disease: The Israeli Experience. Vaccines, 10(3), Article 376. https://doi.org/10.3390/vaccines10030376

@article{e08679cd9555451da5ef771185b1b125,

title = "COVID-19 in Patients with Inflammatory Bowel Disease: The Israeli Experience",

abstract = "Background: Crohn{\textquoteright}s disease (CD) and ulcerative colitis (UC) are chronic, immune-mediated inflammatory bowel diseases (IBD) affecting millions of people worldwide. IBD therapies, designed for continuous immune suppression, often render patients more susceptible to infections. The effect of the immune suppression on the risk of coronavirus disease-19 (COVID-19) is not fully determined yet. Objective: To describe COVID-19 characteristics and outcomes and to evaluate the association between IBD phenotypes, infection outcomes and immunomodulatory therapies. Methods: In this multi-center study, we prospectively followed IBD patients with proven COVID-19. De-identified data from medical charts were collected including age, gender, IBD type, IBD clinical activity, IBD treatments, comorbidities, symptoms and outcomes of COVID-19. A multivariable regression model was used to examine the effect of immunosuppressant drugs on the risk of infection by COVID-19 and the outcomes. Results: Of 144 IBD patients, 104 (72%) were CD and 40 (28%) were UC. Mean age was 32.2 ± 12.6 years. No mortalities were reported. In total, 94 patients (65.3%) received biologic therapy. Of them, 51 (54%) at escalated doses, 10 (11%) in combination with immunomodulators and 9 (10%) with concomitant corticosteroids. Disease location, behavior and activity did not correlate with the severity of COVID-19. Biologics as monotherapy or with immunomodulators or corticosteroids were not associated with more severe infection. On the contrary, patients receiving biologics had significantly milder infection course (p = 0.001) and were less likely to be hospitalized (p = 0.001). Treatment was postponed in 34.7% of patients until recovery from COVID-19, without consequent exacerbation. Conclusion: We did not witness aggravated COVID-19 outcomes in patients with IBD. Patients treated with biologics had a favorable outcome.",

keywords = "Biological drugs, COVID-19, Crohn{\textquoteright}s disease, Immune suppression, Inflammatory bowel disease, Ulcerative colitis",

author = "Lev Lichtenstein and Benjamin Koslowsky and Ya{\textquoteright}acov, {Ami Ben} and Irit Avni-Biron and Baruch Ovadia and Ofer Ben-Bassat and Timna Naftali and Uri Kopylov and Yael Haberman and Eran, {Hagar Banai} and Rami Eliakim and Adi Lahat-Zok and Ayal Hirsch and Eran Zittan and Nitsan Maharshak and Matti Waterman and Eran Israeli and Idan Goren and Ollech, {Jacob E.} and Henit Yanai and Bella Ungar and Benjamin Avidan and Hur, {Dana Ben} and Bernardo Melamud and Ori Segol and Zippora Shalem and Iris Dotan and Odes, {Selwyn H.} and Shomron Ben-Horin and Yf{\textquoteright}At Snir and Yael Milgrom and Efrat Broide and Eran Goldin and Yulia Ron and Cohen, {Nathaniel Aviv} and Eran Maoz and Maya Zborovsky and Safwat Odeh and Freha, {Naim Abu} and Eyal Shachar and Yehuda Chowers and Tal Engel and Hila Reiss-Mintz and Arie Segal and Adar Zinger and Shitrit, {Ariella Bar Gil} and Shmuel Delgado",

note = "Publisher Copyright: {\textcopyright} 2022 by the authors. Licensee MDPI, Basel, Switzerland.",

year = "2022",

month = feb,

day = "28",

doi = "10.3390/vaccines10030376",

language = "English",

volume = "10",

journal = "Vaccines",

issn = "2076-393X",

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Lichtenstein, L, Koslowsky, B, Ya’acov, AB, Avni-Biron, I, Ovadia, B, Ben-Bassat, O, Naftali, T, Kopylov, U, Haberman, Y, Eran, HB, Eliakim, R, Lahat-Zok, A, Hirsch, A, Zittan, E, Maharshak, N, Waterman, M, Israeli, E, Goren, I, Ollech, JE, Yanai, H, Ungar, B, Avidan, B, Hur, DB, Melamud, B, Segol, O, Shalem, Z, Dotan, I, Odes, SH, Ben-Horin, S, Snir, YA, Milgrom, Y, Broide, E, Goldin, E, Ron, Y, Cohen, NA, Maoz, E, Zborovsky, M, Odeh, S, Freha, NA, Shachar, E, Chowers, Y, Engel, T, Reiss-Mintz, H, Segal, A, Zinger, A, Shitrit, ABG & Delgado, S 2022, 'COVID-19 in Patients with Inflammatory Bowel Disease: The Israeli Experience', Vaccines, vol. 10, no. 3, 376. https://doi.org/10.3390/vaccines10030376

TY - JOUR

T1 - COVID-19 in Patients with Inflammatory Bowel Disease

T2 - The Israeli Experience

AU - Lichtenstein, Lev

AU - Koslowsky, Benjamin

AU - Ya’acov, Ami Ben

AU - Avni-Biron, Irit

AU - Ovadia, Baruch

AU - Ben-Bassat, Ofer

AU - Naftali, Timna

AU - Kopylov, Uri

AU - Haberman, Yael

AU - Eran, Hagar Banai

AU - Eliakim, Rami

AU - Lahat-Zok, Adi

AU - Hirsch, Ayal

AU - Zittan, Eran

AU - Maharshak, Nitsan

AU - Waterman, Matti

AU - Israeli, Eran

AU - Goren, Idan

AU - Ollech, Jacob E.

AU - Yanai, Henit

AU - Ungar, Bella

AU - Avidan, Benjamin

AU - Hur, Dana Ben

AU - Melamud, Bernardo

AU - Segol, Ori

AU - Shalem, Zippora

AU - Dotan, Iris

AU - Odes, Selwyn H.

AU - Ben-Horin, Shomron

AU - Snir, Yf’At

AU - Milgrom, Yael

AU - Broide, Efrat

AU - Goldin, Eran

AU - Ron, Yulia

AU - Cohen, Nathaniel Aviv

AU - Maoz, Eran

AU - Zborovsky, Maya

AU - Odeh, Safwat

AU - Freha, Naim Abu

AU - Shachar, Eyal

AU - Chowers, Yehuda

AU - Engel, Tal

AU - Reiss-Mintz, Hila

AU - Segal, Arie

AU - Zinger, Adar

AU - Shitrit, Ariella Bar Gil

AU - Delgado, Shmuel

PY - 2022/2/28

Y1 - 2022/2/28

N2 - Background: Crohn’s disease (CD) and ulcerative colitis (UC) are chronic, immune-mediated inflammatory bowel diseases (IBD) affecting millions of people worldwide. IBD therapies, designed for continuous immune suppression, often render patients more susceptible to infections. The effect of the immune suppression on the risk of coronavirus disease-19 (COVID-19) is not fully determined yet. Objective: To describe COVID-19 characteristics and outcomes and to evaluate the association between IBD phenotypes, infection outcomes and immunomodulatory therapies. Methods: In this multi-center study, we prospectively followed IBD patients with proven COVID-19. De-identified data from medical charts were collected including age, gender, IBD type, IBD clinical activity, IBD treatments, comorbidities, symptoms and outcomes of COVID-19. A multivariable regression model was used to examine the effect of immunosuppressant drugs on the risk of infection by COVID-19 and the outcomes. Results: Of 144 IBD patients, 104 (72%) were CD and 40 (28%) were UC. Mean age was 32.2 ± 12.6 years. No mortalities were reported. In total, 94 patients (65.3%) received biologic therapy. Of them, 51 (54%) at escalated doses, 10 (11%) in combination with immunomodulators and 9 (10%) with concomitant corticosteroids. Disease location, behavior and activity did not correlate with the severity of COVID-19. Biologics as monotherapy or with immunomodulators or corticosteroids were not associated with more severe infection. On the contrary, patients receiving biologics had significantly milder infection course (p = 0.001) and were less likely to be hospitalized (p = 0.001). Treatment was postponed in 34.7% of patients until recovery from COVID-19, without consequent exacerbation. Conclusion: We did not witness aggravated COVID-19 outcomes in patients with IBD. Patients treated with biologics had a favorable outcome.

AB - Background: Crohn’s disease (CD) and ulcerative colitis (UC) are chronic, immune-mediated inflammatory bowel diseases (IBD) affecting millions of people worldwide. IBD therapies, designed for continuous immune suppression, often render patients more susceptible to infections. The effect of the immune suppression on the risk of coronavirus disease-19 (COVID-19) is not fully determined yet. Objective: To describe COVID-19 characteristics and outcomes and to evaluate the association between IBD phenotypes, infection outcomes and immunomodulatory therapies. Methods: In this multi-center study, we prospectively followed IBD patients with proven COVID-19. De-identified data from medical charts were collected including age, gender, IBD type, IBD clinical activity, IBD treatments, comorbidities, symptoms and outcomes of COVID-19. A multivariable regression model was used to examine the effect of immunosuppressant drugs on the risk of infection by COVID-19 and the outcomes. Results: Of 144 IBD patients, 104 (72%) were CD and 40 (28%) were UC. Mean age was 32.2 ± 12.6 years. No mortalities were reported. In total, 94 patients (65.3%) received biologic therapy. Of them, 51 (54%) at escalated doses, 10 (11%) in combination with immunomodulators and 9 (10%) with concomitant corticosteroids. Disease location, behavior and activity did not correlate with the severity of COVID-19. Biologics as monotherapy or with immunomodulators or corticosteroids were not associated with more severe infection. On the contrary, patients receiving biologics had significantly milder infection course (p = 0.001) and were less likely to be hospitalized (p = 0.001). Treatment was postponed in 34.7% of patients until recovery from COVID-19, without consequent exacerbation. Conclusion: We did not witness aggravated COVID-19 outcomes in patients with IBD. Patients treated with biologics had a favorable outcome.

KW - Biological drugs

KW - COVID-19

KW - Crohn’s disease

KW - Immune suppression

KW - Inflammatory bowel disease

KW - Ulcerative colitis

UR - http://www.scopus.com/inward/record.url?scp=85125777986&partnerID=8YFLogxK

U2 - 10.3390/vaccines10030376

DO - 10.3390/vaccines10030376

M3 - Article

AN - SCOPUS:85125777986

SN - 2076-393X

VL - 10

JO - Vaccines

JF - Vaccines

IS - 3

M1 - 376

ER -

COVID-19 in Patients with Inflammatory Bowel Disease: The Israeli Experience

Abstract

Bibliographical note

Keywords

ASJC Scopus subject areas

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