Abstract
BACKGROUND AND AIM: The use of biologics and small molecules has been a concern for patients with inflammatory bowel disease (IBD) during the COVID-19 pandemic. We aimed to assess the association between the risk of COVID-19-related hospitalization and these agents. METHODS: We made a systematic review and meta-analysis of all published studies from December 2019 to September 2021 to identify studies that reported COVID-19-related hospitalization in IBD patients receiving biologic therapies or tofacitinib. We calculated the risk ratio (RR) to compare the relative risk of COVID-19-related hospitalization in patients receiving these medications to those who were not, at the time of the study. RESULTS: Eighteen studies were included. The relative risk of hospitalization was significantly lower in patients with IBD and COVID-19 who were receiving biologic therapy (RR = 0.47 [95% confidence interval, CI: 0.42-0.52, P < 0.00001]) compared to patients not receiving biologics. The RR was lower in patients receiving anti-tumor necrosis factors (TNFs) compared to those who were not (RR = 0.48 [95% CI: 0.41-0.55, P < 0.00001]). A similar finding was observed in patients taking ustekinumab (RR = 0.55 [95% CI: 0.43-0.72, P < 0.00001]). Combination therapy involving anti-TNF and an immunomodulator did not lower the risk of COVID-19-related hospitalization (RR = 0.98 [95% CI: 0.82-1.18, P = 0.84]). The use of vedolizumab (RR = 1.13 [95% CI: 0.75-1.73, P = 0.56]) or tofacitinib (RR = 0.81 [95% CI: 0.49-1.33, P = 0.40]) was not associated with a lower risk of COVID-19-related hospitalization. CONCLUSION: Regarding COVID-19-related hospitalization in IBD, anti-TNFs and ustekinumab were associated with decreased risk of hospitalization. In addition, vedolizumab and tofacitinib were not associated with COVID-19-related hospitalization.