The Henry D Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
Gut. 2021 Apr;70(4):725-732. doi: 10.1136/gutjnl-2020-322539. Epub 2020 Oct 20.
We sought to evaluate COVID-19 clinical course in patients with IBD treated with different medication classes and combinations.
Surveillance Epidemiology of Coronavirus Under Research Exclusion for Inflammatory Bowel Disease (SECURE-IBD) is a large, international registry created to monitor outcomes of IBD patients with confirmed COVID-19. We used multivariable regression with a generalised estimating equation accounting for country as a random effect to analyse the association of different medication classes with severe COVID-19, defined as intensive care unit admission, ventilator use and/or death.
1439 cases from 47 countries were included (mean age 44.1 years, 51.4% men) of whom 112 patients (7.8%) had severe COVID-19. Compared with tumour necrosis factor (TNF) antagonist monotherapy, thiopurine monotherapy (adjusted OR (aOR) 4.08, 95% CI 1.73 to 9.61) and combination therapy with TNF antagonist and thiopurine (aOR 4.01, 95% CI 1.65 to 9.78) were associated with an increased risk of severe COVID-19. Any mesalamine/sulfasalazine compared with no mesalamine/sulfasalazine use was associated with an increased risk (aOR 1.70, 95% CI 1.26 to 2.29). This risk estimate increased when using TNF antagonist monotherapy as a reference group (aOR 3.52, 95% CI 1.93 to 6.45). Interleukin-12/23 and integrin antagonists were not associated with significantly different risk than TNF antagonist monotherapy (aOR 0.98, 95% CI 0.12 to 8.06 and aOR 2.42, 95% CI 0.59 to 9.96, respectively).
Combination therapy and thiopurines may be associated with an increased risk of severe COVID-19. No significant differences were observed when comparing classes of biologicals. These findings warrant confirmation in large population-based cohorts.MKH should be changed to MDK for co-last author line.
我们旨在评估接受不同药物类别和联合治疗的 IBD 患者的 COVID-19 临床病程。
监测排除炎症性肠病的冠状病毒研究中的传染病学（SECURE-IBD）是一个大型国际登记处，旨在监测确诊 COVID-19 的 IBD 患者的结局。我们使用具有广义估计方程的多变量回归，考虑国家作为随机效应，分析不同药物类别与严重 COVID-19 的关联，严重 COVID-19 定义为入住重症监护病房、使用呼吸机和/或死亡。
来自 47 个国家的 1439 例患者（平均年龄 44.1 岁，51.4%为男性）中，有 112 例（7.8%）患有严重 COVID-19。与肿瘤坏死因子（TNF）拮抗剂单药治疗相比，硫嘌呤单药治疗（调整后的比值比（aOR）4.08，95%CI 1.73 至 9.61）和 TNF 拮抗剂与硫嘌呤联合治疗（aOR 4.01，95%CI 1.65 至 9.78）与严重 COVID-19 的风险增加相关。与未使用任何美沙拉嗪/柳氮磺胺吡啶相比，任何美沙拉嗪/柳氮磺胺吡啶的使用与风险增加相关（aOR 1.70，95%CI 1.26 至 2.29）。当以 TNF 拮抗剂单药治疗为参考组时，该风险估计值增加（aOR 3.52，95%CI 1.93 至 6.45）。白细胞介素-12/23 和整合素拮抗剂与 TNF 拮抗剂单药治疗相比，风险无显著差异（aOR 0.98，95%CI 0.12 至 8.06 和 aOR 2.42，95%CI 0.59 至 9.96）。
联合治疗和硫嘌呤可能与严重 COVID-19 的风险增加相关。比较生物制剂的类别时，未观察到显著差异。这些发现需要在大型基于人群的队列中得到证实。MKH 应更改为 MDK 用于共同的最后一位作者行。
