TNF Inhibitors and Risk of Malignancy in Patients with Inflammatory Bowel Diseases: A Systematic Review

Abstract Background and Aims The association between tumour necrosis factor inhibitors [TNFi] and malignancy in patients with inflammatory bowel disease [IBD] is not well understood. Our aim was to systematically evaluate the impact of TNFi use on risk of malignancy in IBD patients in daily clinical practice. Methods We searched Pubmed, Embase and Scopus until March 1, 2020 for observational cohort studies on adult IBD patients reporting malignancy occurrence and TNFi use. Results Twenty-eight studies [20 retrospective and eight prospective] were included, involving 298 717 IBD patients. Mean age at inclusion ranged from 28 to >65 years. Mean follow-up varied from 7 to 80 months. Infliximab was the most frequently used TNFi [13/28 studies, 46.4%], followed by adalimumab [3/28, 10.7%], while both infliximab and adalimumab were evaluated in five studies [17.8%]. In total, 692 malignancies were diagnosed in IBD patients treated with TNFi, accounting for an overall occurrence of 1.0%. The most frequent malignancies were non-melanoma skin cancers [123/692, 17.8%], digestive malignancies [120/692, 17.3%] and haematological malignancies [106/692, 15.3%]. The association between TNFi and malignancy was evaluated in 11 studies [39.3%]: no significant association was found in ten studies, while an increased risk of lymphoma in patients exposed to TNFi was reported in one study. Conclusion TNFi treatment is not associated with an increased risk of malignancy in IBD patients in real-life settings. Further large studies are needed to assess the prognosis of patients exposed to TNFi and risk of recurrence or new cancers in subjects with personal malignancy history.

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P261 Systematic review with meta-analysis: The impact of concomitant immune-mediated diseases on the disease course of inflammatory bowel disease

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjz203.390 ◽

2020 ◽

Vol 14 (Supplement_1) ◽

pp. S280-S281

Author(s):

M Attauabi ◽

M Zhao ◽

F Bendtsen ◽

J Burisch

Keyword(s):

Biologic Therapy ◽

Meta Analysis ◽

Multidisciplinary Care ◽

Disease Course ◽

Immune Mediated ◽

Increased Risk ◽

Bowel Diseases ◽

Inflammatory Bowel ◽

Meta Analyses ◽

The Impact

Abstract Background Several studies have shown an association between inflammatory bowel diseases [IBD] and immune-mediated diseases [IMIDs], but data on the impact of co-occurring IMIDs on IBD course are inconsistent. The aim of this study was to investigate the impact of co-occurring IMIDs on IBD phenotype and disease course. Methods PubMed and EMBASE were searched from database inception through December 2018 and updated in October 2019 for studies reporting prevalences or odds, risks or hazard ratios of IBD-related disease outcomes in patients with and without co-existing IMIDs. Meta-analyses were performed to estimate summary prevalences and risks of the outcomes which included disease extension, IBD-related surgery and hospitalisation, malignancy, mortality and need of medication (biologic therapy, steroids and immunomodulators). IMIDs were stratified into primary sclerosing cholangitis [PSC] and ‘IMIDs other than PSC’. Results A total of 93 studies comprising 14,307 IBD patients with IMIDs and 3,409,914 IBD patients without IMIDs were included in the study. Summary risks and prevalences with 95% confidence intervals for each outcome are presented in figures 1 and 2, respectively. The following results are all significant (p < 0.05). Compared with patients without co-occurring IMIDs, patients with ulcerative colitis [UC] and co-occurring IMIDs other than PSC more frequently received immunomodulators and steroids, and patients with Crohn’s disease [CD] and concomitant IMIDs other than PSC more often received biologic therapy. UC patients with co-existing IMIDs other than PSC more often underwent IBD-related surgery, while patients with CD and PSC received fewer surgeries. In addition, UC patients with co-occurring PSC were at increased risk for having extensive colitis, pancolitis, and malignancies. Patients with UC and PSC had a higher mortality rate, but no difference was found among patients with IMIDs other than PSC. PSC did not influence hospitalisation rates among IBD patients. Conclusion This meta-analysis found that IBD patients with co-existing IMIDs have a different disease course than patients without concomitant IMIDs. This study emphasises the importance of multidisciplinary care of IBD and that physicians caring for IBD patients need to be aware of IMIDs as a prognostic factor.

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P305 Effectiveness and Safety of Vedolizumab in Biologic-Naïve Patients: Real-World Data from the Sicilian Network for Inflammatory Bowel Diseases (SN-IBD)

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjab076.429 ◽

2021 ◽

Vol 15 (Supplement_1) ◽

pp. S333-S333

Author(s):

F Macaluso ◽

W Fries ◽

S Renna ◽

A Viola ◽

M Muscianisi ◽

...

Keyword(s):

Clinical Response ◽

Real World ◽

Primary Outcome ◽

Real World Data ◽

Mayo Score ◽

Significant Difference ◽

Bowel Diseases ◽

Observational Cohort ◽

Inflammatory Bowel

Abstract Background Biologic-naïve patients treated with Vedolizumab (VDZ) are largely underrepresented in real-world cohorts. We performed a multicentre, observational, cohort study on the effectiveness and safety of VDZ as treatment for Crohn’s disease (CD) and ulcerative colitis (UC) among biologic-naïve subjects. Methods Data of consecutive biologic-naïve patients with CD and UC treated with VDZ from July 2016 to December 2019 were extracted from the cohort of the Sicilian Network for Inflammatory Bowel Disease (SN-IBD). The primary outcome was the clinical response at 14 and 52 weeks evaluated with Harvey Bradshaw Index in CD and partial Mayo score in UC. Results 172 consecutive patients (CD: n=88; UC: n=84; median age 66.0 years) were included, with a median follow-up of 58.8 weeks. After 14 weeks, a clinical response was reported in 68.2% of patients with CD and 67.9% of patients with UC treated with VDZ, including 45.5% patients in the CD group and 46.4% patients in the UC group who achieved steroid-free remission. After 52 weeks, a clinical response was reported in 77.4% of CD and in 73.8% of UC patients treated with VDZ, including 59.7% patients in the CD group and 60.7% patients in the UC group who achieved steroid-free remission. All differences between CD and UC were not statistically significant. Cox survival analysis showed no significant difference in the probability of treatment discontinuation between CD and UC patients (log-rank p=0.73). Conclusion This large, real-world, multicenter study demonstrated the effectiveness and safety of VDZ as a first-line biologic, showing high rates of clinical response and steroid-free remission at both induction and maintenance.

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A Brazilian Cohort of Patients With Immuno-Mediated Chronic Inflammatory Diseases Infected by SARS-CoV-2 (ReumaCoV-Brasil Registry): Protocol for a Prospective, Observational Study

JMIR Research Protocols ◽

10.2196/24357 ◽

2020 ◽

Vol 9 (12) ◽

pp. e24357

Author(s):

Claudia Marques ◽

Adriana Maria Kakehasi ◽

Ana Paula Monteiro Gomides ◽

Eduardo Dos Santos Paiva ◽

Edgard Torres dos Reis Neto ◽

...

Keyword(s):

Clinical Laboratory ◽

Inflammatory Diseases ◽

Progression Rate ◽

Immune Mediated ◽

Increased Risk ◽

Observational Cohort ◽

And Function ◽

The Impact ◽

Brazilian Cohort

Background Patients with immune-mediated rheumatic diseases (IMRD) are at increased risk of infections, including significant morbidity and high mortality. Considering the potential for unfavorable outcomes of SARS-CoV-2 infection in patients with IMRD, several questions were raised regarding the impact of COVID-19 at the start of the pandemic. Objective This paper presents the protocol of a study that aims to prospectively evaluate patients with IMRD and a confirmed COVID-19 diagnosis (using criteria provided by the Brazilian Ministry of Health). Methods The study comprised a prospective, observational cohort (patients with IMRD and COVID-19) and a comparison group (patients with only IMRD), with a follow-up time of 6 months to evaluate differences in health outcomes. The primary outcomes will be changes in IMRD disease activity after SARS-CoV-2 infection at 4 time points: (1) at baseline, (2) within 4-6 weeks after infection, (3) at 3 months after the second assessment (±15 days), and (4) at 6 months (±15 days). The secondary outcomes will be the progression rate to moderate or severe forms of COVID-19, need for intensive care unit admission and mechanical ventilation, death, and therapeutic changes related to IMRD. Two outcomes—pulmonary and thromboembolic events in patients with both IMRD and SARS-CoV-2 infection—are of particular interest and will be monitored with close attention (clinical, laboratory, and function tests as well as imaging). Results Recruitment opened in May 2020, with 1300 participants recruited from 43 sites as of November 2020. Patient recruitment will conclude by the end of December 2020, with follow-up occurring until April 2021. Data analysis is scheduled to start after all inclusion data have been collected, with an aim to publish a peer-reviewed paper in December 2020. Conclusions We believe this study will provide clinically relevant data on the general impact of COVID-19 on patients with IMRD. Trial Registration Brazilian Registry of Clinical Trials RBR-33YTQC; http://www.ensaiosclinicos.gov.br/rg/RBR-33ytqc/ International Registered Report Identifier (IRRID) DERR1-10.2196/24357

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Risk of acute arterial events associated with treatment of inflammatory bowel diseases: nationwide French cohort study

Gut ◽

10.1136/gutjnl-2019-318932 ◽

2019 ◽

Vol 69 (5) ◽

pp. 852-858 ◽

Cited By ~ 2

Author(s):

Julien Kirchgesner ◽

Nynne Nyboe Andersen ◽

Fabrice Carrat ◽

Tine Jess ◽

Laurent Beaugerie

Keyword(s):

Incidence Rates ◽

Proportional Hazard ◽

Cox Proportional Hazard ◽

Increased Risk ◽

Bowel Diseases ◽

Cox Proportional Hazard Models ◽

Inflammatory Bowel ◽

Artery Disease ◽

The Impact ◽

Necrosis Factor

ObjectivePatients with IBD are at increased risk of acute arterial events. Antitumour necrosis factor (TNF) agents and thiopurines may, via their anti-inflammatory properties, lower the risk of acute arterial events. The aim of this study was to assess the impact of thiopurines and anti-TNFs on the risk of acute arterial events in patients with IBD.DesignPatients aged 18 years or older and affiliated to the French national health insurance with a diagnosis of IBD were followed up from 1 April 2010 until 31 December 2014. The risks of acute arterial events (including ischaemic heart disease, cerebrovascular disease and peripheral artery disease) were compared between thiopurines and anti-TNFs exposed and unexposed patients with marginal structural Cox proportional hazard models adjusting for baseline and time-varying demographics, medications, traditional cardiovascular risk factors, comorbidities and IBD disease activity.ResultsAmong 177 827 patients with IBD (96 111 (54%) women, mean age at cohort entry 46.2 years (SD 16.3), 90 205 (50.7%) with Crohn’s disease (CD)), 4145 incident acute arterial events occurred (incidence rates: 5.4 per 1000 person-years). Compared with unexposed patients, exposure to anti-TNFs (HR 0.79, 95% CI 0.66 to 0.95), but not to thiopurines (HR 0.93, 95% CI 0.82 to 1.05), was associated with a decreased risk of acute arterial events. The magnitude in risk reduction was highest in men with CD exposed to anti-TNFs (HR 0.54, 95% CI 0.40 to 0.72).ConclusionExposure to anti-TNFs is associated with a decreased risk of acute arterial events in patients with IBD, particularly in men with CD.

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DOP43 Impact of Inflammatory Bowel Diseases on the phenotype and severity of psoriasis and spondyloarthropathies

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjab073.082 ◽

2021 ◽

Vol 15 (Supplement_1) ◽

pp. S081-S081

Author(s):

M Attauabi ◽

M Damsgaard Wewer ◽

F Bendtsen ◽

J B Seidelin ◽

J Burisch

Keyword(s):

Systematic Review ◽

Inflammatory Bowel Diseases ◽

Meta Analysis ◽

Disease Phenotype ◽

Model Quality ◽

High Quality ◽

Increased Risk ◽

Bowel Diseases ◽

Inflammatory Bowel ◽

The Impact

Abstract Background It is unclear whether inflammatory bowel diseases (IBD) affect the phenotype and severity of co-occurring axial spondyloarthropathies (axSpA) and psoriasis. Therefore, we aimed to investigate the characteristics of axSpA and psoriasis in relation to co-occurring IBD. Methods The systematic review and meta-analysis were conducted according to Cochrane’s recommendations. PubMed and EMBASE were searched from database inception till January 2020 for studies reporting disease phenotype and severity of axSpA and psoriasis in association with co-occurrence of IBD. Meta-analyses were performed using a random-effects model. Quality of the studies was assessed by the Newcastle-Ottawa Scale (NOS). Results The electronic search yielded 12,220 studies which were narrowed down to 152 after screening based on study titles and abstracts. Of these, a full-text review identified 20 eligible studies, including twelve and eight studies describing characteristics of axSpA and psoriasis, respectively, in relation to IBD. AxSpA was identified among a total of 321 and 8,660 patients with and without a co-occurring IBD, respectively, and the studies’ mean NOS score was 6.8, including seven and five studies of moderate and high quality, respectively. The meta-analysis demonstrated that presence of co-occurring IBD was associated with an increased risk of dactylitis (risk ratio (RR)=2.06 (95%CI 1.24–3.42), I2=0%), but not enthesitis (RR=0.93 (95%CI 0.48–1.81), I2=86%). Furthermore, IBD was associated with a significantly lower Bath Ankylosing Spondylitis Radiology Index (mean difference (meandiff) -2.28 (95%CI -3.26-(-1.30)), p<0.01, I2=0%), better Schober’s test results (meandiff 0.80 (95%CI 0.64–1.49), p<0.01, I2=0%), and a lower finger to floor distance (meandiff -6.36 (95%CI -10.36-(-2.36)), p<0.01, I2=0%). The phenotype of psoriasis was assessed among 680 and 222,279 patients with and without a co-occurring IBD. The mean NOS score was 7.4, including two studies of moderate methodological quality, while the remaining six studies were of high quality. The presence of IBD was associated with a significantly less frequent presentation of psoriasis in the nails (RR=0.14 (95%CI 0.05–0.42), I2=0%) but not psoriatic arthritis (RR=0.94 (95%CI 0.27–3.31), I2=75%). Finally, the presence of IBD was associated with a milder phenotype of psoriasis (RR=1.41 (95%CI 1.02–1.96), p=0.04, I2=70%). Conclusion This is the first systematic review with meta-analysis investigating the impact of IBD on the disease phenotype and severity of psoriasis and axSpA. Our data suggest that IBD modifies psoriasis and axSpA to be milder and emphasizes the importance of a multidisciplinary approach to patients with psoriasis or axSpA and co-occurring IBD.

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P506 The Impact of Anxiety in Patients With Inflammatory Bowel Diseases Treated With Biologics during COVID Lockdown. A Comparative Study between Hospitalized and non-hospitalized patients

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjab076.628 ◽

2021 ◽

Vol 15 (Supplement_1) ◽

pp. S487-S488

Author(s):

L Bertani ◽

B Barberio ◽

F Zanzi ◽

D Maniero ◽

L Ceccarelli ◽

...

Keyword(s):

Inflammatory Bowel Diseases ◽

Depression Scale ◽

Stressful Events ◽

Psychological Status ◽

Fisher Exact Test ◽

Increased Risk ◽

Bowel Diseases ◽

Inflammatory Bowel ◽

The Impact ◽

At Home

Abstract Background The first wave of COVID-19 pandemic management implied to remain at home in order to reduce the spread of the infection. Several patients with inflammatory bowel diseases (IBD) treated with biologics had to go to the hospital to perform intravenous (i.v.) therapies, whereas patients treated with subcutaneous (s.c.) ones could remain at home. Since immumodulatory therapies as well as the access to high-risk places like hopitals have been associated to an increased risk of infections, we have investigated whether patients hospitalized or treated at home showed similar levels of anxiety related to the pandemic situation. Methods We conducted a survey including consecutive IBD patients treated with biologics at three Italian referral centers referring to the first lockdown period. We included consecutive adult patients in clinical and biochemical remission treated with biologics, administered i.v. or s.c. Patients experiencing a disease flare during these months were excluded from the study, in order to avoid potential biases related to disease activity. Patients underwent the normally scheduled clinical visits, performed at home by using phone or video calls for patients treated with s.c. drugs and only in specific cases (i.e. suspected COVID symptoms) for patients treated with i.v. ones. We administered to all patients the Hospital Anxiety and Depression Scale (HADS) questionnaire and other 11 questions, specifically related to COVID and its implications. Group differences in continuous and nominal variables were tested by Kruskal–Wallis test and Fisher exact test, respectively. Results A total of 189 IBD patients were recruited, 112 (59.3%) treated with i.v. drugs and 77 (40.7%) with s.c. ones. The two groups of patients had similar scores in the 14 single items of the HADS questionnaire (p>0.10 for all). The total HADS score obtained by the sum of all items was also almost identical between groups (37.1 ± 2.8 vs 37.2 ± 2.8; p=0.98). In patients treated with i.v. drugs receiving a televisit (n=17), the rates of satisfaction about telemedicine (58.8%) and the lack of in-person care (33.3%) were significantly lower compared with those treated with s.c. drugs (94.8% and 92.2%, respectively; both p<0.0005). Conclusion Our results suggest that there is no need to convert patients from i.v. to s.c. therapy, since the risk of infection as well as of disease relapse due to stressful events are similar in both groups. Moreover, the hospitalization for drug administration does not affect the the psychological status of the patients. Interestingly, patients used to coming to the hospital have more need for in-person contact than patients used to be treated at home, suggesting that the choice of telemedicine should be personalized.

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Risk factors for SARS-CoV-2 infection and course of COVID-19 disease in patients with IBD in the Veterans Affair Healthcare System

Gut ◽

10.1136/gutjnl-2021-324356 ◽

2021 ◽

pp. gutjnl-2021-324356

Author(s):

Nabeel Khan ◽

Nadim Mahmud ◽

Chinmay Trivedi ◽

Walter Reinisch ◽

James D Lewis

Keyword(s):

Healthcare System ◽

Veterans Affairs ◽

Secondary Outcome ◽

Disease Course ◽

Increased Risk ◽

National Cohort ◽

Inflammatory Bowel ◽

The Impact ◽

Related Mortality

ObjectiveOur 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.DesignThis 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.ResultsThe 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).ConclusionVDZ 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.

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Frailty and Risk of Serious Infections in Biologic-treated Patients With Inflammatory Bowel Diseases

Inflammatory Bowel Diseases ◽

10.1093/ibd/izaa327 ◽

2020 ◽

Author(s):

Siddharth Singh ◽

Herbert C Heien ◽

Lindsey Sangaralingham ◽

Nilay D Shah ◽

Jennifer C Lai ◽

...

Keyword(s):

Inflammatory Bowel Diseases ◽

Frailty Index ◽

Administrative Claims ◽

Serious Infection ◽

Increased Risk ◽

Serious Infections ◽

Comorbidity Burden ◽

Bowel Diseases ◽

Inflammatory Bowel

Abstract Background Identifying biologic-treated patients with inflammatory bowel diseases (IBDs) at higher risk of serious infections is a priority. We conducted a retrospective cohort study evaluating frailty and risk of serious infections in biologic-treated patients with IBD. Methods Using an administrative claims database, we identified biologic-treated patients with IBD between 2014 and 2018 with follow-up 1 year before and after treatment initiation. Using a validated claims-based hospital frailty risk scoring system, patients were classified as frail and nonfrail. We compared the risk of serious infections (infections requiring hospitalization) between frail and nonfrail patients using Cox proportional hazard analysis adjusting for age, comorbidities, disease characteristics, health care utilization, use of corticosteroids, immunomodulators, and opiates. Results We included 5987 biologic-treated patients with IBD (4881 on TNFα antagonists, 1106 on vedolizumab), of whom 2350 (39.3%) were classified as frail; over 7115 person-years of follow-up was included, and 520 patients developed serious infection. Frailty was not associated with increased risk of serious infection (adjusted hazard ratio [aHR], 1.12; 95% CI, 0.93–1.36), whereas advanced age (older than 60 years), high comorbidity burden, corticosteroid use, opiate use, and prior serious infection were associated with increased risk of serious infection. On stratified analysis, frailty was associated with increased risk of serious infections in vedolizumab-treated patients (aHR, 1.69; 95% CI, 1.03–2.79) but not in TNFα antagonist-treated patients (aHR, 1.03; 95% CI, 0.83–1.27). Conclusions In biologic-treated patients with IBD, frailty assessed using a claims-based frailty index was not independently associated with increased risk of serious infections. Future studies evaluating objective and biological measures of frailty are warranted to risk-stratify older patients with IBD.

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Effectiveness and Safety of Golimumab in Treating Outpatient Ulcerative Colitis: A Real-Life Prospective, Multicentre, Observational Study in Primary Inflammatory Bowel Diseases Centers

Journal of Gastrointestinal and Liver Diseases ◽

10.15403/jgld.2014.1121.263.trs ◽

2017 ◽

Vol 26 (3) ◽

pp. 239-244 ◽

Cited By ~ 15

Author(s):

Antonio Tursi ◽

Leonardo Allegretta ◽

Nello Buccianti ◽

Nicola Della Valle ◽

Walter Elisei ◽

...

Keyword(s):

Ulcerative Colitis ◽

Inflammatory Bowel Diseases ◽

Real Life ◽

Fecal Calprotectin ◽

Mucosal Healing ◽

C Reactive Protein ◽

Reactive Protein ◽

Bowel Diseases ◽

Inflammatory Bowel

Background & Aims: Golimumab (GOL) has been recently approved in Italy for the treatment of ulcerative colitis (UC) unresponsive to standard treatments. Our aims were to assess the real-life efficacy and safety of GOL in managing UC outpatients in Italian primary Inflammatory Bowel Diseases (IBD) centres.Methods: Consecutive UC outpatients with at least 3-months follow-up were enrolled. Primary end-point was the induction and maintenance of remission in UC, defined as Mayo score ≤2, at 6-month follow-up.Results: Ninety-three patients were enrolled. At 6-month follow-up, remission was obtained in 34 (36.5%) patients. Shorter duration of disease was the only significant predictive factor of remission. Clinical response was achieved in 60 (64.5%) patients, while mucosal healing (MH) was obtained in 18 (19.3%) patients. Sixteen (47.0%) patients under remission were still under therapy with steroids. C-reactive protein and fecal calprotectin significantly dropped during the follow-up (p<0.001 for both proteins). Adverse events occurred in 4 (4.3%) patients and 3 of them stopped treatment. Colectomy was performed in only one patient (1.1%).Conclusions: Golimumab seems to be safe and effective in inducing and maintaining remission in real life UC outpatients.Abbreviations: ADA: Adalimumab; CRP: C-reactive Protein; GOL: Golimumab; FC: Fecal calprotectin; IBD: Inflammatory Bowel Diseases; IFX: Infliximab; IQR: Interquartile range; MH: Mucosal Healing; SC: Subcutaneously; TBC: Tuberculosis; TNFα: Tumor necrosis factor α; UC: Ulcerative Colitis.

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Concerns and attitudes of patients with inflammatory bowel diseases during the COVID-19 pandemic

10.21203/rs.3.rs-112091/v1 ◽

2020 ◽

Author(s):

Matina-Lydia Chatzinikolaou ◽

Eirini Zacharopoulou ◽

Georgios Kokkotis ◽

Maria Palatianou ◽

Stamatina Vogli ◽

...

Keyword(s):

Preventive Measures ◽

Relevant Information ◽

Sources Of Information ◽

Sense Of Security ◽

Increased Risk ◽

Bowel Diseases ◽

Negative Effect ◽

Inflammatory Bowel ◽

Coronavirus Infection ◽

The Impact

Abstract Background: The coronavirus disease 2019 (COVID-19) pandemic has changed inflammatory bowel disease (IBD) care. The use of telemedicine was quickly adopted, however the impact of COVID-19 on IBD patients’ feelings and sense of security for their health has not been extensively evaluated.Aims: Our aim was to assess patients’ views and concerns regarding their IBD condition, compliance with treatment and preventive measures, accessibility to health services and sources of information they used during the coronavirus pandemic.Methods: A questionnaire-based survey of patients with IBD (n=237) was conducted at a University and an NHS GI Units.Results: Greek patients with IBD expressed high levels of fear of coronavirus infection, with more than 50% being afraid of dying as a result of COVID-19. Seven out of ten participants felt that their IBD medications increased risk of infection and this fear was significantly higher in patients on immunosuppression. Only 2% of patients discontinued treatment on their own, all of whom were receiving immunosuppression. More than 90% of participants reported staying home and washing their hands. Three quarters of patients had access to a doctor when needed and almost 50% used the electronic paperless prescription system. Participants were satisfied with the information they received regarding COVID-19. The main sources of information were media, internet and social networks, with only one third seeking guidance from their gastroenterologist. Conclusions: The COVID-19 pandemic had a profound, negative effect on IBD patients’ lives. COVID-19-related fears need to be actively addressed, particularly in IBD patients on immunosuppression, and relevant information should be continuously provided.

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