Conti CB, Mainardi E, Soro S, Testa S, De Silvestri A, Drago A, Cereatti F, Grassia R. SARS-CoV-2 in inflammatory bowel disease population: Antibodies, disease and correlation with therapy. World J Gastrointest Endosc 2022; 14(3): 153-162 [PMID: 35432745 DOI: 10.4253/wjge.v14.i3.153]
Corresponding Author of This Article
Clara Benedetta Conti, MD, Consultant Physician-Scientist, Department of Gastroenterology and Digestive Endoscopy, ASST Cremona, Viale Concordia 1, Cremona 26100, Italy. benedetta.conti1@gmail.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Observational Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Endosc. Mar 16, 2022; 14(3): 153-162 Published online Mar 16, 2022. doi: 10.4253/wjge.v14.i3.153
SARS-CoV-2 in inflammatory bowel disease population: Antibodies, disease and correlation with therapy
Clara Benedetta Conti, Elsa Mainardi, Sara Soro, Sophie Testa, Annalisa De Silvestri, Andrea Drago, Fabrizio Cereatti, Roberto Grassia
Clara Benedetta Conti, Sara Soro, Andrea Drago, Fabrizio Cereatti, Roberto Grassia, Department of Gastroenterology and Digestive Endoscopy, ASST Cremona, Cremona 26100, Italy
Elsa Mainardi, Sophie Testa, Department of Laboratory Medicine, Haemostasis and Thrombosis Center, ASST Cremona, Cremona 26100, Italy
Annalisa De Silvestri, Department of Clinic Epidemiology and Biometric, Scientific Direction, Fondazione IRCCS Policlinico San Matteo, Pavia 27100, Italy
Author contributions: Conti CB and Grassia R conceived and planned the study; Mainardi E, Grassia R, Drago A, Cereatti F, Soro S and Testa S carried out the tests and collected the data; Testa S and Mainardi E contributed to the interpretation of the results; De Silvestri A performed the statistical analysis; Conti CB wrote the manuscript; all authors provided critical feedback and helped the research and analysis of the manuscript.
Institutional review board statement: The study was reviewed and approved by the Institutional Review Board Comitato EticoVal Padana.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: No conflict of interest.
Data sharing statement: Technical appendix, statistical code, and data set available from the corresponding author at benedetta.conti1@gmail.com. Participants gave informed consent for data collection and data are recorded anonymized. Risk of identification is very low.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Clara Benedetta Conti, MD, Consultant Physician-Scientist, Department of Gastroenterology and Digestive Endoscopy, ASST Cremona, Viale Concordia 1, Cremona 26100, Italy. benedetta.conti1@gmail.com
Received: October 11, 2021 Peer-review started: October 11, 2021 First decision: December 3, 2021 Revised: December 14, 2021 Accepted: February 16, 2022 Article in press: February 16, 2022 Published online: March 16, 2022 Processing time: 155 Days and 22.6 Hours
Abstract
BACKGROUND
Guidelines recommend to cease inflammatory bowel disease (IBD) biologic therapy during coronavirus disease 2019 (COVID-19).
AIM
To investigate severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibody positivity in an IBD cohort, COVID-19 disease severity and to evaluate the correlation with clinical/therapeutic variables.
METHODS
Prospective observational cohort study. IBD patients were tested for SARS-CoV-2 IgG. Data on COVID-19 disease, demographics/therapeutics and clinical features of the IBD population were collected. IgG ≥ 7 was set for SARS-CoV-2 antibody positivity. Throat swab was performed in cases of IgG positivity. Correlations between antibody positivity or COVID-19 symptoms and therapeutic/clinical data were assessed.
RESULTS
In total, 103 IBD patients were enrolled. Among them, 18.4% had IgG ≥ 7. Multivariate analysis of antibody positivity correlated only with IBD treatment. For IgG ≥ 7, the odds ratio was 1.44 and 0.16 for azathioprine and mesalazine, respectively, vs biologic drugs (P = 0.0157 between them). COVID-19 related symptoms were reported in 63% of patients with IgG positivity. All but one patient with COVID-19 symptoms did not require ceasing IBD treatment or hospitalization. IBD treatment and body mass index correlated with COVID-19 disease development with symptoms.
CONCLUSION
The IBD population does not have a higher risk of severe COVID-19. The relative risk of having SARS-CoV-2 antibodies and symptoms was higher for patients taking azathioprine, then biologic therapy and lastly mesalazine. None of the patients under biologic therapy developed severe COVID-19.
Core Tip: Guidelines recommend ceasing inflammatory bowel disease (IBD) biologic therapy during coronavirus disease 2019 (COVID-19). IBD patients were prospectively tested for severe acute respiratory syndrome coronavirus 2 IgG. In total, 103 IBD patients were enrolled. We found that 18.4% had IgG positivity, and 63% developed COVID-19 disease with symptoms. However, all but one patient with symptoms did not require ceasing IBD treatment no hospitalization. None of the patients under biologic therapy developed severe COVID-19. Therefore, the IBD population does not seem to have a high risk of severe COVID-19, particularly if under biological treatment or mesalazine.
