Q: In patients with inflammatory bowel disease (IBD), use of which of the following is found to have increased risk of COVID-19? (select one)
B) anti-TNF therapy
Overall patients with IBD have found to have no higher risk than the general population to acquire COVID-19, although patients on active treatment may have higher risk. Surprisingly, patients on glucocorticoids are found to have higher risk than patients on anti-TNF therapy (TNF = Tumor necrosis Factor).
The gastrointestinal (GI) symptoms in COVID are due to the presence of widely expressed angiotensin-converting enzyme 2 (ACE2) receptors in the intestine. They are most prevalent in the cytoplasm of gastric cells, intestinal epithelial cells, and the cilia of glandular epithelial cells.
Caution: Literature on COVID-19 is still evolving.
1. Norsa L, Indriolo A, Sansotta N, et al. Uneventful Course in Patients With Inflammatory Bowel Disease During the Severe Acute Respiratory Syndrome Coronavirus 2 Outbreak in Northern Italy. Gastroenterology 2020; 159:371.
2. Rubin DT, Feuerstein JD, Wang AY, Cohen RD. AGA Clinical Practice Update on Management of Inflammatory Bowel Disease During the COVID-19 Pandemic: Expert Commentary. Gastroenterology 2020; 159:350.
3. Brenner EJ, Ungaro RC, Gearry RB, et al. Corticosteroids, But Not TNF Antagonists, Are Associated With Adverse COVID-19 Outcomes in Patients With Inflammatory Bowel Diseases: Results From an International Registry. Gastroenterology 2020; 159:481.