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P422 COVID 19 infection in IBD patients treated with biologic therapy-experience from tertiary center in Serbia

Sokic Milutinovic, A.(1);Jevtovic, M.(2);Jovicic, I.(1);

(1)Clinical Centre of Serbia, Clinic for Gastroenterology and Hepatology, Belgrade, Serbia;(2)University of Belgrade, School of Medicine, Belgrade, Serbia

Background

COVID 19 pandemic is caused by newly discovered coronavirus that started end of December 2019 and is ongoing. Patients with severe forms of Crohn`s disease (CD) and ulcerative colitis (UC) treated with biologic therapy are considered to be at increased risk of infectious diseases due to the immunosuppressive effect of biologic drugs. Available guidelines recommend that biologic therapy is continued during the pandemic. Since data on COVID 19 infection in this subgroup of IBD patients is limited we aimed to assess presence of risk factors related to virus transmission, incidence and severity of COVID 19 infection in patients on biologic therapy in tertiary center in Serbia.

Methods

Study was conducted in Clinic for Gastroenterology and Hepatology, Clinical center of Serbia. We included 263 IBD patients on biologic therapy in the study (mean age 41±13, 142 males). There were 162 CD and 101 UC patients. Standardized questionnaire was used to assess presence of different risk factors relevant for virus transmission and also symptoms and severity of disease if patient was infected with COVID 19.

Results

 Out of 263 patients 41 (22 CD, 19 UC) was COVID 19 positive. Mean age of COVID 19 positive patients was 43±14, 19 were males and 22 females. In COVID 19 positive group 26 patients were on anti-TNF therapy (15 on infliximab and 6 on adalimumab), while 15 were treated with vedolizumab. Risk factors for COVID 19 infection were use of public transportation (p<0.05), active disease (p<0.05), residency in capital city (p<0.05) and presence of COVID 19 infection in a household member (p<0.05). Other factors such as age, sex, blood type, use of conventional immunosuppressive therapy and class of biologic drug did not differ between infected and uninfected group. Pneumonia was diagnosed in 7 patients (17%) and hospital admission was necessary in 4 cases (9.75%). All hospitalized patients were using corticosteroids due to relapse of IBD. Most common symptoms of infection were fever in 26 (63.4%), tiredness in 19 (46.3%) and loss of taste and smell in 17 (41.4%) patients. All patients recovered successfully and none needed mechanical ventilation.

Conclusion

Use of biologic therapy during COVID 19 pandemic is safe in IBD patients. Since we did not observe any fatal outcomes and all patients had mild to moderate COVID 19 presentation it is possible that biologic therapy, especially anti-TNF, has a protective role in preventing cytokine storm during COVID 19 infection.

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