Secure-IBD, the Epidemiology of COVID-19, and IBD

The Secure-IBD project is an international effort being led by doctors at the University of North Carolina at Chapel Hill and Icahn School of Medicine at Mount Sinai, New York to act as a database of outcomes of COVID-19 occurring in patients with IBD. At their site, https://covidibd.org, they are collecting data on reports of coronavirus cases as well as providing summaries of that data.

If you have IBD and were diagnosed with coronavirus, you should encourage your doctor to fill out a report here. The more data available, the more we can better predict how people with IBD will be impacted by the coronavirus.

I looked over the current data set of 638 cases to see what we know today. The U.S. has nearly a third of the reported cases and almost two times that of Spain. This is interesting as the overall IBD rate is similar between the two countries (Spain 0.4%, versus U.S. 0.5%.). Most of the cases in the U.S. are unsurprisingly centered in New York (~35%), with Louisiana, Illinois, New Jersey, and Massachusetts rounding out the rest of the states with double-digit reported cases (California is right behind with 9).

Overall, IBD patients have not been severely impacted with 8% developing serious enough symptoms to require an ICU visit, ventilator, or died from complications (3% of reported patients died). I wonder if these numbers reflect how people with IBD are often living a life that has some social distancing built in, whether because of disease state, or social anxieties? COVID-19 appears to be hitting people with UC (ulcerative colitis) harder than people with Crohn’s disease, with 11% of patients needing serious interventions versus Crohn’s, 6% and a death rate of 5% versus 2%, respectively.

Interestingly, the biggest factor for severity doesn’t appear to be disease state, where people reported as, “in remission” have a 3% death rate, only 1% lower than people with moderate to severe disease. The biggest factor seems to additional co-morbidities or patients with more than one chronic disease or condition. Patients with no other co-morbidities had a death rate of just 1%, but that jumps up to 11% with the addition of a single condition and 23% with two.

When it comes to medications, only two patients (nearly one-third of all reported patients) taking Anti-TNF drugs, such as Humira, Remicade, and Inflectra died. Just 3% of patients on these drugs required serious interventions. As the news of the “cytokine storm” has unfolded, I wondered if my Infliximab infusions would be a protectant, as TNF-α is a key cytokine in a cytokine storm. It appears, so far at least, that this is true. The next biggest group of medications reported for patients was mesalamine/sulfasalazine and the death rate for reported patients taking these medications was 7% and 19% had needed serious intervention.

I feel pretty good going into my Remicade infusion tomorrow, having this data. I mentioned in my last post that now is a terrible time to mess with what is working and having the Remicade on board may actually prove to be more of a protectant should I become infected with the coronavirus than my state of remission.

*One last little mystery from the data is the death rate and serious complications jump to 3% and 15% respectively when the Anti-TNF is combined with 6MP or methotrexate, a common practice, though I did not respond well to methotrexate. It would be interesting to get on the horn with an expert on this combination and see what is happening there.

Data :
Brenner EJ, Ungaro RC, Colombel JF, Kappelman MD.
SECURE-IBD Database Public Data Update.
covidibd.org.
Accessed on 04/20/20