High-risk group has emerged unscathed despite the COVID-19 pandemic

Diet and lifestyle 7. nov 2020 3 min MD, PhD, clinical epidemiologist Johan Burisch Written by Morten Busch

Many people with chronic noncommunicable diseases were anxious when the COVID-19 pandemic broke out in spring 2020. Many of these people were identified as having a high risk of severe illness and potential death, including people with inflammatory bowel disease (IBD). In addition to the increased risk from IBD, doctors did not know whether the medication increased that risk further. A new major study refutes the concern about the medication and shows that the 35,000 people with IBD in Denmark have significantly lower susceptibility to developing COVID-19 than people without IBD – probably because they have taken better care of themselves.

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What do you do if your medication might put your life at risk? Millions of people around the world had to ask themselves this question when COVID-19 changed the world we knew. People with IBD, such as Crohn’s disease, take immunosuppressive drugs, and these were feared to make these people more susceptible to becoming infected with SARS-CoV-2. A new study shows no reason for concern.

“We found that significantly fewer people with IBD have been infected with and died from SARS-CoV-2. Although we know today that immunosuppressive drugs such as corticosteroids alleviate the symptoms among people already ill with COVID-19, we are very certain that the reason that people with IBD have a lower infection rate is that they have taken better care of themselves than others. Our latest figures suggest that the increased anxiety and stress these people experienced over the past 6 months because they feared an increased risk of COVID-19 infection because of their medication has been unfounded,” explains Johan Burisch, a PhD and doctor at the Copenhagen Center for Inflammatory Bowel Disease in Children, Adolescents and Adults, University of Copenhagen, Hvidovre Hospital, Denmark.

No concern about IBD medication

People with immune-mediated inflammatory diseases such as IBD are especially interesting during the COVID-19 pandemic, since many receive immunosuppressive therapy, which increases the risk of infection.

“When the pandemic erupted, we were swamped by worried people who wanted to know what to do and whether to continue taking their medication. Similar to many other relevant questions during the pandemic, we had a very hard time giving a definite answer because there were no studies,” says Johan Burisch.

The new investigation is the first population-based study to examine the risk of developing COVID-19 and its illness trajectory among people with IBD. The researchers investigated the general population tested for COVID-19 to determine the prevalence among people with and without IBD but also among people with other immune-mediated inflammatory diseases.

“People with IBD, including Crohn’s disease and ulcerative colitis, secrete increased concentrations of angiotensin-converting enzyme 2 receptor, which potentially enables SARS-CoV-2 to be transmitted. We had also feared that the immunosuppressive drugs would cause many more of these people to develop COVID-19, but the evidence did not suggest this,” explains Johan Burisch.

Only 2.5% of the people with IBD tested positive for COVID-19 versus 3.2% for the people with immune-mediated inflammatory diseases and 3.7% for the general population.

“The evidence indicates that people with IBD do not have a significantly higher infection rate and that they should not be concerned about taking their usual medication,” says Johan Burisch.

Since recent research has shown that corticosteroids can actually help people who develop COVID-19 survive, these immunosuppressive drugs may reduce the incidence of COVID-19, but the researchers do not have enough evidence to conclude this.

“We found no evidence that immunosuppressive drugs have benefits in the early stages of COVID-19, and previous studies show that adrenocorticotropic hormone especially increases the risk of infection. However, we assume instead that people with immune-mediated inflammatory diseases have been tested more often and probably also take better care of themselves,” explains Johan Burisch.

No reason for greater concern

In addition to investigating the percentage of people developing COVID-19, the researchers also studied the people with IBD who developed COVID-19 to examine their illness trajectory, since people with noncommunicable diseases were identified early as having greater risk for severe illness.

“Our study found no evidence to suggest that immunosuppressive therapy or IBD affects the actual trajectory of COVID-19, either the length of illness or the incidence of severe COVID-19. Among people with IBD who developed COVID-19, 20% needed hospitalization and 5% needed intensive care,” says Johan Burisch.

According to the researchers, the good news is that neither COVID-19 nor the medication should give rise to additional concern among people with IBD. The study asked people being treated for IBD to report the level of stress they experienced since the COVID-19 pandemic erupted and found that they have considerably greater risk of severe stress.

“Our patients were constantly seeking advice on COVID-19 from reliable sources. They have experienced considerable stress from seeking information that did not exist and thus from not knowing whether to take their medication and whether they had greater risk of developing COVID-19 and dying from it. Actively reaching out to the people with IBD is therefore extremely important, even those who do not have COVID-19 symptoms, so that they can get the right information, advice and guidelines and know that they do not have to worry more than anyone else,” concludes Johan Burisch.

Prevalence and outcomes of COVID-19 among patients with inflammatory bowel disease – a Danish prospective population-based cohort study” has been published in the Journal of Crohn’s and Colitis. In 2020, the Novo Nordisk Foundation awarded a grant to Johan Burisch for the project The Influence of Genetics, Immunity and Microbiome on the Prognosis of Inflammatory Bowel Disease – the IBD Prognosis Study.

I'm a medical doctor and gastroenterologist situated in Copenhagen, Denmark. My research focuses on inflammatory bowel disease and on its epidemiology...

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