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

Gut. 2021 Apr;70(4):725-732. doi: 10.1136/gutjnl-2020-322539. Epub 2020 Oct 20.


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.MKH should be changed to MDK for co-last author line.

Keywords: infectious disease; inflammatory bowel disease.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Anti-Inflammatory Agents / pharmacology
  • Azathioprine* / administration & dosage
  • Azathioprine* / adverse effects
  • COVID-19* / diagnosis
  • COVID-19* / epidemiology
  • COVID-19* / immunology
  • Drug Therapy, Combination / methods
  • Drug Therapy, Combination / statistics & numerical data
  • Female
  • Humans
  • Inflammatory Bowel Diseases* / drug therapy
  • Inflammatory Bowel Diseases* / virology
  • International Cooperation
  • Male
  • Mercaptopurine* / administration & dosage
  • Mercaptopurine* / adverse effects
  • Registries / statistics & numerical data
  • Risk Adjustment
  • SARS-CoV-2* / drug effects
  • SARS-CoV-2* / isolation & purification
  • Severity of Illness Index
  • Tumor Necrosis Factor Inhibitors* / administration & dosage
  • Tumor Necrosis Factor Inhibitors* / adverse effects


  • Anti-Inflammatory Agents
  • Tumor Necrosis Factor Inhibitors
  • Mercaptopurine
  • Azathioprine