P026 Inflammatory Bowel Disease (IBD) Related Outcomes in Patients Diagnosed With COVID-19
Authors: Spandorfer Adam , Lue Nicole , Iskandar Heba , Naidu Harini , Jewell Lisa , Eskreis David , Woolard Lisa , Prasad Meena , Dhere Tanvi 
Published: December 2021

BACKGROUND:
Patients with IBD report increased gastrointestinal symptoms, including diarrhea, abdominal pain, and nausea following COVID-19 diagnosis. While there has been a great amount of research assessing outcomes of COVID-19 in patients with IBD, little is known about the effects of COVID-19 on IBD disease activity. We aimed to explore IBD related outcomes in a cohort of IBD patients affected by COVID-19.

METHODS:
We performed a retrospective case series of patients with IBD who were diagnosed with COVID-19 and seen in a single tertiary care referral center from March 2020 to March 2021 after IRB approval. We compared patients who were in stable remission up to 90 days prior to the COVID-19 diagnosis to those who were not in remission during the same time frame. COVID-19 diagnosis was made based on a combination of symptoms and positive rapid antigen and/or PCR test. Disease activity was estimated based on routinely measured clinical disease severity indices documented in office visit notes, including partial Mayo score for ulcerative colitis (UC) or Harvey-Bradshaw Index for Crohn's disease (CD) and/or endoscopic scoring documented in procedure notes including Mayo endoscopic subscore for UC or simple endoscopic score for CD documented in the procedure notes. For the primary outcome, we assessed IBD related outcomes by determining the need for escalation of immunosuppressive maintenance therapy, and/or need for IBD related hospitalization/surgery within 3 months after diagnosis of COVID-19. For the secondary outcome, COVID-19 related outcomes were assessed including need for hospitalization, ICU stay, use of COVID-19 related therapy such as monoclonal antibodies, and death. Continuous variables were compared between groups using student t test. Categorical variables were compared using Chi-square test.

RESULTS:
We identified 57 eligible patients. At the time of COVID-19 diagnosis, 30 (52.6%) were in remission, 0 (0%) had mild disease, 23 (40.3%) had moderate disease activity, and 4 (7.0%) had severe disease activity. No patients discontinued maintenance medications for more than 14 days due to COVID-19 diagnosis. No differences in age, gender, race, body max index, and combordities were noted between those not in remission versus those who were in remission (p>0.05). Patients who were not in remission were more likely to be on steroids at the time of COVID-19 diagnosis (47% vs 0%, p =0.00001) including budesonide and prednisone. Patients who were not in remission were more likely to be on biologics at the time of COVID-19 diagnosis (96.3%% vs 73.3%, p =0.03). Patients in remission had overall low rates of needing escalation in immunosuppressive maintenance therapy and IBD related hospitalization/surgery (6.7% and 0%, respectively). Patients who were not in remission were more likely to require escalation in immunosuppressive maintenance therapy (44.4% vs 6.7%, p 0.0015) and IBD related hospitalization/surgery compared to those in remission (18.5% vs 0.0%, p=0.02). No differences in COVID-19 related outcomes including need for hospitalization, ICU stay, use of COVID-19 related therapy such as monoclonal antibodies, and death were noted between the two groups (p>0.05).

CONCLUSION:
Our study suggests minimal impact of COVID-19 on IBD related outcomes in patients in remission. Patients who were not in remission did have worse IBD related outcomes compared to those in remission, however, the findings could reflect the natural history of IBD related disease rather than being related to COVID-19. COVID-19 related outcomes were no different in those who were not in remission versus those who were in remission. Future larger scale studies are warranted to study the findings further.