Stephen Hanauer, MD, on Immunologic Lessons From COVID 19

Dr Hanauer discusses his presentation at the Interdisciplinary Autoimmune Summit 2022 on lessons learned during the pandemic about risks to and care of patients with inflammatory bowel disease.

Stephen Hanauer, MD, is the Clifford Joseph Barborka Professor of Medicine at the Feinberg School of Medicine and medical director of the Digestive Health Center at Northwestern University in Chicago, Illinois.

TRANSCRIPT:

I'm Dr. Steve Hanauer. I'm professor of medicine and medical director of the Digestive Health Center at Northwestern University in Northwestern Medicine here in Chicago. And I have joined my 2 other senior advisors at the Interdisciplinary Autoimmune Summit, Dr. Leonard Calabrese and Joel Gelfand, specialists in rheumatology and dermatology, in a discussion regarding what we have learned related to the immune-mediated diseases and COVID-19 infections.

I have taken the perspective of inflammatory bowel disease—ulcerative colitis and Crohn's disease. And I'm extremely proud of our subspecialty in IBD, because at the onset of the epidemic, we initiated studies regarding the risk of COVID in patients with ulcerative colitis and Crohn's disease around the world in an international survey called the Secure Analysis, which has been on the online since approximately February or March of 2020. By completing this survey around the world, we learned early on that the risk factors for developing COVID and its complications in the setting of inflammatory bowel disease were really not significantly different from the general population.

Indeed, it was not the presence of Crohn's disease or ulcerative colitis that added risk for developing COVID symptoms or complications, or hospitalizations, or deaths, nor were COVID hospitalizations, deaths, and ICU visits increased by most of the medications that we use. Indeed, despite using immunomodulatory agents, such as thiopurines, methotrexate, mesalamine compounds, tumor necrosis factor inhibition, biologics targeting lymphocyte trafficking to the gut, or even cytokine inhibition with ustekinumab, did not increase the risk of hospitalizations, ICU, or death in the IBD population.

In contrast, we've seen that the general risk factors of comorbidities such as diabetes, lung disease, or heart disease, have really been the main influencers of COVID risks to our patient population. And this has been very reassuring. In contrast, we've also confirmed that steroids can be a negative factor in the risk for COVID and complications. Now, this is a little bit ironic, of course, because high doses of steroids are also used within the setting of serious infections with COVID. So our treatment of IBD through the COVID epidemic really has not changed significantly. All along, we try to limit corticosteroid exposure. Now, despite the fact that the SARS-CoV-2 virus has receptors within the gut and also shed from the gut, most of the viral particles that are shedding from the gut are not live and are not contagious or infectious.

But the next question that came is whether or not COVID infections increase flare-ups of inflammatory bowel disease, the risk of COVID on IBD itself. And for the most part, we've also found very little interaction. COVID can cause a gastroenteritis, and many patients with or without IBD may have transient gut symptoms. But it's pretty uncommon for patients to have significant flare-ups of their IBD despite getting COVID infections, as long as they've been undergoing continued treatment for their inflammatory bowel disease.

And the final point of our discussion is the impact of our medications and the diseases on vaccine uptake. And similar to what we've learned with COVID infections, per se, we have not seen increased risk of complications of COVID vaccinations in patients with inflammatory bowel disease, independent of their individual therapies. But just as we've seen with other diseases and other immune diseases, high doses of corticosteroids can blunt the vaccine response. It doesn't eliminate it, but antibody levels to the spike protein may be somewhat lower in patients who are receiving high doses of steroids compared to other medications or patients without treatment.

But we have also identified that the vaccines are highly effective in patients with inflammatory bowel disease, similar to what we've seen in the general population. And that vaccines continue to reduce the risk of hospitalizations and complications of COVID, even in patients with Crohn's and ulcerative colitis, who are undergoing medical therapy. Thank you.