key: cord-0852273-ri3tnfdv
authors: Markovic, Srdjan; Ivanovski, Tamara Knezevic; Zogovic, Branimir; Kalaba, Ana; Zaric, Dusan; Svorcan, Petar
title: The Effect of COVID-19 Resurgence on Morbidity and Mortality in Patients With IBD on Biologic Therapy
date: 2021-03-09
journal: Inflamm Bowel Dis
DOI: 10.1093/ibd/izab048
sha: ca2777e20f06b4740d32db300280fcc9da54ba3b
doc_id: 852273
cord_uid: ri3tnfdv

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The Effect of COVID-19 Resurgence on Morbidity and Mortality in Patients With IBD on Biologic Therapy

To the Editors, Around the time that we composed our letter to Inflammatory Bowel Diseases, 1 Serbia saw a surge in patients with COVID-19. As a result, a number of patients with inflammatory bowel disease (IBD) on biologic therapy were infected with COVID-19. This development was in contrast to the situation described in the letter, 1 in which patients with IBD who had continued their biologic therapy during the March-June 2020 lockdown successfully avoided COVID-19. In October 2020, our University Hospital Medical Center Zvezdara, located in Belgrade, was once more transformed into a COVID-19 center. This time around, a part of the building was redeveloped into a non-COVID-19 area to allow nondisruptive service for patients with IBD. One hundred eighty-one patients with Crohn disease (CD) and 106 patients with ulcerative colitis (UC) were enrolled to receive biologic therapy in October. Infliximab, adalimumab, and vedolizumab were scheduled for administration to 105, 95, and 87 patients, respectively. The patients were observed from October until the end of January 2021.

Twenty-five of the 287 patients were affected by COVID-19, 17 who had CD and 8 who had UC. The infliximab group had 10 patients infected with COVID-19, 5 who had CD and 5 who had UC. There were 12 patients infected by COVID-19 in the adalimumab group, all of whom had CD. Finally, 3 patients on vedolizumab therapy who were treated for UC were infected by COVID-19. A full report of patient data on biologics and their COVID-19 status are reported in Table 1 .

All patients were in clinical and endoscopic remission at the time they contracted COVID-19. Biologic therapy was suspended during the course of COVID-19. Although most of the patients had benign clinical illness, we recorded 1 mortality and 2 patients with morbidity. A 66-year-old patient with UC on vedolizumab therapy who also suffered from diabetes mellitus and deep vein thrombosis unfortunately succumbed to COVID-19. Two of the patients with CD on infliximab had bilateral pneumonia. Because of acute respiratory distress and elevated serum interleukin-6 levels at 44.9 pg/mL, 1 of these patients was treated with a tocilizumab injection, which subsequently curbed the respiratory distress, and the patient had a successful convalescence.

The mechanisms of interactions between anti-interleukin-6 and infliximab in patients infected with COVID-19 are unknown; however, they may represent grounds for research in that our patient's biologic therapy for CD continued to be successful. All patients resumed their IBD biologic therapy 2 weeks after complete resolution of COVID-19 symptoms. Author contributions: SM, TKI, and PS conceptualized the study and acquired the data. SM, BZ, AK, and DZ analyzed and interpreted the data for the work. All authors contributed to drafting the work and approved the final version. All authors agree to be accountable for all aspects of the study. 

Biological therapy for inflammatory bowel disease during the COVID-19 pandemic: experiences from a tertiary IBD service