Inflammatory Bowel Disease Patients With Coronavirus Disease 2019: The Picture Is Taking Shape.

Dear Editor:

We read with interest the systematic review on inflammatory bowel disease (IBD) patients with coronavirus disease 2019 (COVID-19) published by D’Amico et al. The authors provided a comprehensive and up-to-date picture on the epidemiologic and clinical characteristics of IBD patients affected by COVID-19. We would like to elaborate on some points covered in their review. In particular, D’Amico et al reported a cumulative prevalence of COVID-19 among IBD patients of 0.4%. This prevalence rate appears to be comparable with that found in the general population. Indeed, Taxonera et al recently reported that when these data were adjusted for age of the patients, a significantly lower standardized risk of COVID-19 was observed in patients with IBD compared with the general population (odds ratio, 0.74; 95% CI, 0.70–0.77; P < .001). We suggest that the reassuring prevalence rates of COVID-19 reported in patients with IBD largely are owing to IBD patients adhering to the preventive measures recommended by gastroenterologists. This belief also is confirmed by the absence of COVID-19 cases in 2 cohort studies of IBD patients from regions with a high prevalence of COVID-19 such as Wuhan (China) and Bergamo (Lombardy, Italy), where strict preventive measures were taken. , The major preventive measures consisted of social distancing, hand washing, the use of personal protective equipment as recommended by the health authorities, and the creation of specific dedicated paths for patients who needed to access the hospital for the administration of biological infusion therapies. Obviously, similar preventive measures have been ensured for the health personnel involved in the management of these patients. Furthermore, all unnecessary visits were replaced with telemedicine. Hospitalizations and endoscopies were limited to emergencies. These positive results should encourage clinicians to continue diligent protection of patients with IBD, even in those countries where the pandemic curve has flattened. The persistence of active outbreaks of severe acute respiratory syndrome coronavirus 2 could lead to a second wave of viral spread. Obviously, in countries with a reduction in the incidence of the pandemic, diagnostic, endoscopic, and nonurgent surgical activities are resuming according to an order of priority decided on a case-by-case basis. Resumption strategies always should favor the safety of patients and health professionals.

Another point to consider is that the clinical course of COVID-19 in patients with IBD has been reported to be milder than in the general population, as evidenced by a lower mortality rate (3.8% vs 10%). The reported lower mortality rate may be owing to the relatively younger age and lower number of comorbidities in patients with IBD. However, we cannot exclude a beneficial effect of therapies used for IBD treatment. In particular, anti–tumor necrosis factor-α agents can provide 2 beneficial effects. First, these agents maintain the disease in remission. Second, in cases of severe acute respiratory syndrome coronavirus 2 infection, the tumor necrosis factor-α antagonists may mitigate the course of the disease by preventing or reducing the pulmonary and systemic injury provoked by the cytokines storm. , In conclusion, data on the epidemiology and clinical features of COVID-19 in patients with IBD are accumulating, and we hope that this improved knowledge will translate into greater certainty about the safe management of patients with IBD in the era of COVID-19.