Effect of IBD medications on COVID-19 outcomes: Results from an international registry

Ryan C. Ungaro, Erica J. Brenner, Richard B. Gearry, Gilaad G. Kaplan, Michele Kissous-Hunt, James D. Lewis, Siew C. Ng, Jean Francois Rahier, Walter Reinisch, Flávio Steinwurz, Fox E. Underwood, Xian Zhang, Jean Frederic Colombel, Michael D. Kappelman

Research output: Contribution to journalArticlepeer-review

198 Scopus citations


Objective We sought to evaluate COVID-19 clinical course in patients with IBD treated with different medication classes and combinations. Design Surveillance Epidemiology of Coronavirus Under Research Exclusion for Inflammatory Bowel Disease (SECURE-IBD) is a large, international registry created to monitor outcomes of IBD patients with confirmed COVID-19. We used multivariable regression with a generalised estimating equation accounting for country as a random effect to analyse the association of different medication classes with severe COVID-19, defined as intensive care unit admission, ventilator use and/or death. Results 1439 cases from 47 countries were included (mean age 44.1 years, 51.4% men) of whom 112 patients (7.8%) had severe COVID-19. Compared with tumour necrosis factor (TNF) antagonist monotherapy, thiopurine monotherapy (adjusted OR (aOR) 4.08, 95% CI 1.73 to 9.61) and combination therapy with TNF antagonist and thiopurine (aOR 4.01, 95% CI 1.65 to 9.78) were associated with an increased risk of severe COVID-19. Any mesalamine/sulfasalazine compared with no mesalamine/sulfasalazine use was associated with an increased risk (aOR 1.70, 95% CI 1.26 to 2.29). This risk estimate increased when using TNF antagonist monotherapy as a reference group (aOR 3.52, 95% CI 1.93 to 6.45). Interleukin-12/23 and integrin antagonists were not associated with significantly different risk than TNF antagonist monotherapy (aOR 0.98, 95% CI 0.12 to 8.06 and aOR 2.42, 95% CI 0.59 to 9.96, respectively). Conclusion Combination therapy and thiopurines may be associated with an increased risk of severe COVID-19. No significant differences were observed when comparing classes of biologicals. These findings warrant confirmation in large population-based cohorts.

Original languageEnglish
Pages (from-to)725-732
Number of pages8
Issue number4
StatePublished - 1 Apr 2021


  • infectious disease
  • inflammatory bowel disease


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