Center for Clinical Epidemiology, Odense University Hospital, 5000 Odense C, Denmark.
Research Unit of Clinical Epidemiology, Department of Clinical Research, University of Southern Denmark, 5000 Odense C, Denmark.
Inflamm Bowel Dis. 2023 Sep 1;29(9):1470-1476. doi: 10.1093/ibd/izad070.
It is not known whether coronavirus 2019 (COVID-19) is a trigger for disease activity in patients with inflammatory bowel diseases (IBD). In patients with IBD, we aimed to examine the association between COVID-19 infection and prescriptions of systemic and local corticosteroids (used as proxy for disease activity).
This nationwide cohort study was based on Danish health registries and included all patients in Denmark with ulcerative colitis (UC) or Crohn's disease (CD) by the start of the pandemic (March 1, 2020) and who had a positive COVID-19 polymerase chain reaction (PCR) test from March 1, 2020, to July 31, 2022. We calculated rates of corticosteroid prescriptions 6 months before and 6 months after a positive COVID-19 PCR test, and we calculated adjusted incidence rate ratios (aIRR).
We included 30,102 patients with IBD and a positive COVID-19 test (11,159 with CD, 18,493 with UC). The aIRR for having corticosteroid prescriptions after a COVID-19 positive test was 0.85 (95% confidence interval [CI], 0.79-0.91). When we stratified for underlying disease, the aIRR for having corticosteroid after a COVID-19 positive test in UC was 0.82 (95% CI, 0.75-0.90), and in CD 0.91 (95% CI, 0.81-1.02). Stratifications according to calendar periods and age groups showed consistent results.
An infection with COVID-19 did not result in a higher rate of filled corticosteroid prescriptions. Using corticosteroids as a proxy for disease activity, COVID-19 did not seem to trigger disease activity, which is a reassuring result for patients with IBD.
目前尚不清楚 2019 年冠状病毒病（COVID-19）是否会引发炎症性肠病（IBD）患者的疾病活动。在 IBD 患者中，我们旨在研究 COVID-19 感染与全身和局部皮质类固醇（用作疾病活动的替代指标）处方之间的关联。
这是一项全国性队列研究，基于丹麦健康登记处，纳入了 2020 年 3 月 1 日大流行开始时患有溃疡性结肠炎（UC）或克罗恩病（CD）的所有丹麦患者，以及 2020 年 3 月 1 日至 2022 年 7 月 31 日期间 COVID-19 聚合酶链反应（PCR）检测阳性的患者。我们计算了 COVID-19 PCR 检测阳性前 6 个月和后 6 个月皮质类固醇处方的发生率，并计算了调整后的发病率比（aIRR）。
我们纳入了 30102 名患有 IBD 和 COVID-19 检测阳性的患者（11159 名 CD，18493 名 UC）。COVID-19 检测阳性后皮质类固醇处方的 aIRR 为 0.85（95%置信区间[CI]，0.79-0.91）。当我们按基础疾病分层时，UC 患者 COVID-19 检测阳性后皮质类固醇处方的 aIRR 为 0.82（95%CI，0.75-0.90），CD 患者为 0.91（95%CI，0.81-1.02）。根据日历时段和年龄组进行的分层显示出一致的结果。
COVID-19 感染不会导致皮质类固醇处方率升高。使用皮质类固醇作为疾病活动的替代指标，COVID-19 似乎并未引发疾病活动，这对于 IBD 患者来说是一个令人安心的结果。
