Letter: the effect of anti-COVID-19 treatment on the outcome of patients with inflammatory bowel disease.

LINKED CONTENT

This article is linked to Hadi et al papers. To view these articles, visit https://doi.org/10.1111/apt.16730

Editors,

We read with great interest the recent study by Hadi et al investigating the incidence, outcomes and impact of COVID‐19 on inflammatory bowel disease (IBD). Using propensity‐matched research network analysis, the authors reported several significant findings: (1) the risk of COVID‐19 was lower in IBD patients compared to the non‐IBD population; (2) patients with IBD were at increased risk for requiring hospitalisation due to COVID‐19 compared to non‐IBD population, but with no differences in need for mechanical ventilation or mortality; (3) IBD patients on corticosteroids were at an increased risk of the need for critical care; and (4) up to 7% of patients with IBD infected with COVID‐19 suffered an IBD flare 3 months later.

We have several concerns about these issues. First, the effect of anti‐COVID‐19 treatment on the clinical outcomes of patients with COVID‐19 was not assessed. Many treatments have been demonstrated to have clinical efficacy and safety in the management of patients with COVID‐19. For COVID‐19 outpatients, neutralising monoclonal antibody can significantly reduce the risk of hospitalisation or ED visits. For hospitalised patients with COVID‐19, remdesivir may help reduce time to clinical improvement, and corticosteroid and anti‐IL‐6 could be associated with a lower mortality rate than usual care or placebo. , In addition, the severity of the initial COVID‐19 infection is an important prognostic factor determining the outcome of patients with SARS‐CoV‐2 infection. The outcome of asymptomatic or mild symptomatic SARS‐CoV‐2 infection would be more favourable than those with COVID‐19 pneumonia or acute respiratory distress syndrome. Therefore, the effect of anti‐COVID‐19 treatment and the severity of COVID‐19 need to be assessed in the outcome analysis of patients with and without IBD. After adjusting for these two important confounding factors, the role of IBD among patients with COVID‐19 may be clearer. Moreover, the effect of these two anti‐inflammatory agents—corticosteroid and anti‐IL‐6—on the further development and flare‐up of IBD after COVID‐19 requires further investigation.

Second, we had a minor concern about the finding of a lower incidence of COVID‐19 in patients with IBD than those without IBD. The diagnosis of COVID‐19 in patients with IBD could potentially be underestimated as IBD patients may share some similar non‐specific sign and symptoms with COVID‐19 or patients with IBD may receive fewer tests for SARS‐CoV‐2 infection than those without IBD. A further sensitivity test is warranted.

Third, although the authors demonstrated the prior use of corticosteroid would negatively affect the clinical outcome of COVID‐19, further analysis about the dose–responsive relationship and the treatment duration of corticosteroid is needed to establish the adverse role of corticosteroid on the IBD patients with COVID‐19.

In conclusion, despite the useful information arising from this detailed analysis about the association between IBD and COVID‐19 infection, we raised some concerns about several potential confounding factors—anti‐COVID‐19 treatment, disease severity of COVID‐19, the diagnostic tests for COVID‐19 and the usage of corticosteroids—that were not addressed.

AUTHOR CONTRIBUTIONS

Cheng‐Yi Wang: Conceptualization (equal); writing – original draft (lead). Chih‐Cheng Lai: Conceptualization (lead); writing – review and editing (lead).