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Min Ho Lee 1, Han Jacob Li 2, Paul Wasuwanich 2, Sung Eun Kim 1, Jong Yeob Kim 1, Gwang Hun Jeong 3, Seoyeon Park 1, Jae Won Yang 4, Min Seo Kim 5, Dong Keon Yon 6 7, Seung Won Lee 8, Ai Koyanagi 9 10, Louis Jacob 9 11 12, Eun-Young Kim 13, Jae Hee Cheon 14, Jae Il Shin 15, Lee Smith 16
1Yonsei University College of Medicine, Seoul, Republic of Korea.
2University of Florida College of Medicine, University of Florida, Gainesville, Florida, USA.
3Gyeongsang National University College of Medicine, Jinju, Republic of Korea.
4Department of Nephrology, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea.
5Department of Digital Health, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Seoul, Republic of Korea.
6Department of Pediatrics, Kyung Hee University College of Medicine, Seoul, Korea.
7Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Seoul, Republic of Korea.
8Department of Precision Medicine, Sungkyunkwan University School of Medicine, Suwon, Republic of Korea.
9Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, ISCIII, Barcelona, Spain.
10ICREA, Barcelona, Spain.
11Faculty of Medicine, University of Versailles Saint-Quentin-en-Yvelines, Montigny-le-Bretonneux, France.
12Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain.
13Department of Health, Social and Clinical Pharmacy, Evidence-Based and Clinical Research Laboratory, College of Pharmacy, Chung-Ang University, Seoul, Korea.
14Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
15Department of Pediatrics, Yonsei University College of Medicine, Seoul, Republic of Korea.
16The Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge, UK.
Min Ho Lee, Han Jacob Li, Paul Wasuwanich, Sung Eun Kim, Jong Yeob Kim, Gwang Hun Jeong, Seoyeon Park and Jae Won Yang these authors contributed equally to this work.
CORRESPONDING AUTHOR : Jae Il Shin
Abstract
The susceptibility, risk factors, and prognosis of COVID-19 in patients with inflammatory bowel disease (IBD) remain unknown. Thus, our study aims to assess the prevalence and clinical outcomes of COVID-19 in IBD. We searched PubMed, EMBASE, and medRxiv from 2019 to 1 June 2022 for cohort and case-control studies comparing the prevalence and clinical outcomes of COVID-19 in patients with IBD and in the general population. We also compared the outcomes of patients receiving and not receiving 5-aminosalicylates (ASA), tumour necrosis factor antagonists, biologics, systemic corticosteroids, or immunomodulators for IBD. Thirty five studies were eligible for our analysis. Pooled odds ratio of COVID-19-related hospitalisation, intensive care unit (ICU) admission, or death in IBD compared to in non-IBD were 0.58 (95% confidence interval (CI) = 0.28-1.18), 1.09 (95% CI = 0.27-4.47), and 0.67 (95% CI = 0.32-1.42), respectively. Inflammatory bowel disease was not associated with increased hospitalisation, ICU admission, or death. Susceptibility to COVID-19 did not increase with any drugs for IBD. Hospitalisation, ICU admission, and death were more likely with 5-ASA and corticosteroid use. COVID-19-related hospitalisation (Odds Ratio (OR): 0.53; 95% CI = 0.38-0.74) and death (OR: 0.13; 95% CI = 0.13-0.70) were less likely with Crohn's disease than ulcerative colitis (UC). In conclusion, IBD does not increase the mortality and morbidity of COVID-19. However, physicians should be aware that additional monitoring is needed in UC patients or in patients taking 5-ASA or systemic corticosteroids.
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