Treatment adaptations and outcomes of patients experiencing inflammatory bowel disease flares during the early COVID-19 pandemic: the PREPARE-IBD multicentre cohort study.

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Authors
Brookes, Matthew
Issue Date
2022-11-01
Journal
Type
Cohort Study
Multicentre Study
Observational Study
Peer-Reviewed Publication
Keywords
Inflammatory bowel disease
COVID-19
Adrenal cortex hormones
Ulcerative colitis
Crohn's disease
Prednisolone
Ustekinumab
PREPARE-IBS Collaborators
Treatment outcomes
Treatment adaptations
Journal Title
Alimentary Pharmacology and Therapeutics (AP&T)
Volume
56
56
Issue
10
10
Begin page
1060
End page
1474
1474
Abstract
Background The COVID-19 pandemic offered a unique opportunity to understand inflammatory bowel disease (IBD) management during unexpected disruption. This could help to guide practice overall. Aims To compare prescribing behaviour for IBD flares and outcomes during the early pandemic with pre-pandemic findings Methods We performed an observational cohort study comprising patients who contacted IBD teams for symptomatic flares between March and June 2020 in 60 National Health Service trusts in the United Kingdom. Data were compared with a pre-pandemic cohort after propensity-matching for age and physician global assessment of disease activity. Results We included 1864 patients in each of the pandemic and pre-pandemic cohorts. The principal findings were reduced systemic corticosteroid prescription during the pandemic in Crohn's disease (prednisolone: pandemic 26.5% vs. 37.1%; p < 0.001) and ulcerative colitis (UC) (prednisolone: pandemic 33.5% vs. 40.7%, p < 0.001), with increases in poorly bioavailable oral corticosteroids in Crohn's (pandemic 15.6% vs. 6.8%; p < 0.001) and UC (pandemic 11.8% vs. 5.2%; p < 0.001). Ustekinumab (Crohn's and UC) and vedolizumab (UC) treatment also significantly increased. Three-month steroid-free remission in each period was similar in Crohn's (pandemic 28.4% vs. 32.1%; p = 0.17) and UC (pandemic 36.4% vs. 40.2%; p = 0.095). Patients experiencing a flare and suspected COVID-19 were more likely to have moderately-to-severely active disease at 3 months than those with a flare alone.
Citation
Saifuddin A, Kent AJ, Mehta SJ, Hicks LC, Gonzalez HA, Segal JP, Brookes MJ, Subramanian S, Bhala N, Conley TE, Patel KV; PREPARE-IBD Collaborators, Lamb CA, Walker GJ, Kennedy NA, Sebastian S. Treatment adaptations and outcomes of patients experiencing inflammatory bowel disease flares during the early COVID-19 pandemic: the PREPARE-IBD multicentre cohort study. Aliment Pharmacol Ther. 2022 Nov;56(10):1460-1474. doi: 10.1111/apt.17223. Epub 2022 Oct 5. PMID: 36196569.