Yousaf Hadi1, Gursimran S Kochhar2. 1. Department of Gastroenterology & Hepatology, West Virginia University, Morgantown, West Virginia, USA. 2. Department of Gastroenterology & Hepatology, Allegheny Health Network, Pittsburgh, Pennsylvania, USA.
We appreciate Wang et al. for their insightful comments and their interest in our manuscript.
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The authors raised three concerns.Several therapeutic agents are now available that aim to alter the course of COVID‐19 disease. These include anti‐IL6 and corticosteroids as the authors have mentioned. We did not study the impact of individual COVID‐19 therapeutic regimens on disease course in patients with IBD. However, no concerns regarding any therapeutic agent has been raised in co‐existing IBD, and therefore, theoretically the use of these agents should not be different in the IBD cohort when compared to the general population. Regarding the severity of the COVID‐19 infection, it is in fact one of the outcomes of our analysis. We aimed to study the disease course of COVID‐19 in the IBD cohort in comparison to the general population, and thus this variable does not warrant adjustment. In fact, adjusting for COVID‐19 severity would introduce beta error to our study.Second, we note the authors' concern that patients with IBD could potentially be underdiagnosed with COVID‐19 due to similar non‐specific sign and symptoms with COVID‐19 that may mimic their inflammatory bowel disease. On the contrary, we noted that patients with IBD, in fact, were more likely to be tested for COVID‐19 in our cohort (likely due to their ‘closer connection’ with the healthcare system due to an underlying chronic disease).Third, regarding the prior corticosteroid use query, we did not aim to study any dose response relationship of corticosteroid use. We found an adverse relationship of prior corticosteroid use in patients with IBD and COVID‐19 outcomes. Prior corticosteroid use in these patients with IBD is a surrogate marker for poor underlying disease control (the actual variable we were trying to study), and the objective was not to assess the impact of the corticosteroids on COVID‐19 outcome.
AUTHOR CONTRIBUTIONS
Yousaf Hadi: Data curation (equal). Gursimran Kochhar: Writing – review and editing (equal).