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DOP40 Comorbidities and epidemiological risk factor but not immunosuppressive therapies increase the risk of COVID-19 in Inflammatory Bowel Disease (IBD): An ENEIDA-based, case-control study

Zabana Abdo, Y.(1,2);Marín-Jiménez, I.(3);Rodríguez-Lago, I.(4);Vera, I.(5);Martín, M.D.(6);Guerra, I.(7);Gisbert, J.P.(2,8);Mesonero, F.(9);Benítez, O.(1);Taxonera, C.(10);Ponferrada-Díaz, Á.(11);Piqueras, M.(12);Lucendo, A.(2,13);Caballol, B.(2,14);Mañosa, M.(2,15);Martínez-Montiel, P.(16);Bosca-Watts, M.(17);Gordillo, J.(18);Bujanda, L.(19);Manceñido, N.(20);Martínez-Pérez, T.(21);López, A.(22);Rodríguez, C.(23);García-López, S.(24);Vega, P.(25);Rivero, M.(26);Melcarne, L.(27);Calvo, M.(28);Iborra, M.(2,29);Barreiro-de Acosta, M.(30);Arias, L.(31);Barrio, J.(32);Pérez, J.L.(33);Busquets, D.(34);Pérez-Martínez, I.(35);Navarro-Llavat, M.(36);Hernández, V.(37);Argüelles-Arias, F.(38);Domènech, E.(2,15);Esteve, M.(1,2)

(1)Hospital Universitari Mútua de Terrassa, Gastroenterology Department- Inflammatory Bowel Disease Unit, Terrassa, Spain;(2)Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas CIBEREHD, CIBERehd, Madrid, Spain;(3)Hospital Gregorio Marañón, Gastroenterology Department, Madrid, Spain;(4)Hospital de Galdakao, Gastroenterology Department, Bilbao, Spain;(5)Hospital Universitario Puerta de Hierro Majadahonda, Gastroenterology Department, Majadahonda, Spain;(6)Hospital Universitario La Paz, Gastroenterology Department, Madrid, Spain;(7)Hospital Universitario de Fuenlabrada and Instituto de Investigación Hospital Universitario La Paz IdiPaz, Gastroenterology Department, Madrid, Spain;(8)Hospital Universitario de La Princesa and Instituto de Investigación Sanitaria Princesa IIS-IP, Gastroenterology Department, Madrid, Spain;(9)Hospital Universitario Ramón y Cajal, Gastroenterology Department, Madrid, Spain;(10)Hospital Clínico San Carlos- Instituto de Investigación del Hospital Clínico San Carlos [IdISSC], Gastroenterology Department, Madrid, Spain;(11)Hospital Universitario Infanta Leonor, Gastroenterology Department, Madrid, Spain;(12)Consorci Sanitari de Terrassa, Gastroenterology Department, Terrassa, Spain;(13)Hospital General de Tomelloso and Instituto de Investigación Sanitaria Princesa IIS-IP, Gastroenterology Department, Tomelloso, Spain;(14)Hospital Clínic de Barcelona, Gastroenterology Department, Barcelona, Spain;(15)Hospital Universitari Germans Trias i Pujol, Gastroenterology Department, Badalona, Spain;(16)Fundación Hospital Universitario Doce de Octubre Madrid, Gastroenterology Department, Madrid, Spain;(17)Hospital Clinic Universitari de Valencia, Gastroenterology Department, Valencia, Spain;(18)Hospital de la Santa Creu i Sant Pau, Gastroenterology Department, Barcelona, Spain;(19)Hospital Universitario Donostia and Instituto Biodonostia- Universidad del País Vasco UPV/EHU, Gastroenterology Department, Donostia, Spain;(20)Hospital Universitario Infanta Sofía, Gastroenterology Department, San Sebastián de los Reyes, Spain;(21)Hospital Virgen de la Luz, Gastroenterology Department, Cuenca, Spain;(22)Hospital del Mar and Institut Hospital del Mar d’Investigacions Mèdiques IMIM Barcelona, Gastroenterology Department, Barcelona, Spain;(23)Complejo Hospitalario de Navarra, Gastroenterology Department, Navarra, Spain;(24)Hospital Universitario Miguel Servet, Gastroenterology Department, Zaragoza, Spain;(25)Complexo Hospitalario Universitario de Ourense, Gastroenterology Department, Ourense, Spain;(26)Hospital Universitario Marques de Valdecilla IDIVAL, Gastroenterology Department, Santander, Spain;(27)Hospital Universitari Parc Taulí, Gastroenterology Department, Sabadell, Spain;(28)Hospital San Pedro, Gastroenterology Department, Logroño, Spain;(29)Hospital Universitario y Politécnico de la Fe de Valencia, Gastroenterology Department, Valencia, Spain;(30)Hospital Universitario de Santiago "CHUS", Gastroenterology Department, Santiago de Compostela, Spain;(31)Hospital Universitario de Burgos, Gastroenterolgy Department, Burgos, Spain;(32)Hospital Universitario Río Hortega HURH, Gastroenterology Department, Valladolid, Spain;(33)Hospital Universitario Fundación de Alcorcón, Gastroenterology Department, Alcorcón, Spain;(34)Hospital Universitari de Girona Doctor Josep Trueta, Gastroenterology Department, Girona, Spain;(35)Hospital Universitario Central de Asturias and Instituto de Investigación Sanitaria del Principado de Asturias ISPA, Gastroenterology Department, Oviedo, Spain;(36)Hospital de Sant Joan Despí Moises Broggi, Gastroenterology Department, Sant Joan Despí, Spain;(37)Hospital Álvaro Cunqueiro Vigo, Gastroenterology Department, Vigo, Spain;(38)Hospital Universitario Virgen de la Macarena- Universidad de Sevilla, Gastroenterology Department, Sevilla, Spain; COVID-19-EII Consortium of the ENEIDA project of GETECCU

Background

The information regarding IBD patients with COVID-19 suggests that the factors related to bad outcome are older age and comorbidity whereas immunosuppressants do not have a significant impact worsening the disease evolution. To date, there is no information to assess if there are differences in epidemiological, demographical, and clinical characteristics between infected and non-infected IBD patients.

Methods

Case-control study in IBD patients with COVID-19 (cases) compared to IBD without COVID-19 (controls) in the period March-July/2020 within the ENEIDA registry (promoted by GETECCU and with more than 60.000 IBD patients included). Cases were matched 1:2 by age (±5y), type of disease (CD/UC), gender, and centre. All controls were selected from only one investigator blind to other clinical characteristics of the patients to avoid selection bias.

Results

496 cases and 964 controls from 63 Spanish centres were included. No differences were found within the basal characteristics including CD location, CD behaviour, extraintestinal manifestations, family history of IBD or smoking habits. Cases had ≥ 1 comorbidities (cases:43%vs. controls:36%, p=0.01) and occupational risk (cases:27% vs. controls:10.6%, p<0.0001) in a higher proportion. Strict lockdown but not sick leave nor telecommuting was the only measure demonstrating protection against COVID-19 (cases:49% vs. controls:70%, p<0.0001). There were no differences in the use of systemic steroids (p=0.19), immunosuppressants (p=0.54) or biologics (p=0.25) between cases and controls. Cases were more often treated with aminosalicylates (45% vs.34%, p=0.022). Having ≥ 1 comorbidities (OR:1.4, 95%CI: 1-1.8), occupational risk (OR:2.05, 95%CI:1.5-2.9) and the use of aminosalicylates (OR:1.4, 95%CI: 1-1.8) were risk factors for COVID-19. On the other hand, the strict lockdown was a protective factor (OR:0.36, CI:0.27-0.48).

Conclusion

Comorbidities and epidemiological risk factors are the most relevant aspects for the risk of COVID-19 in IBD patients. This risk of COVID-19 seems to be increased by aminosalicylates but not by immunosuppressants or biologics. The attitude regarding treating IBD patients with aminosalicylates during the COVID-19 pandemic deserves a deeper analysis. 
Funded by the Carlos III Health Institute COV20/00227.

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