Chronisch-entzündliche Darmerkrankungen in der COVID-Pandemie: Manifestationen und Management

Zusammenfassung

Die COVID-19-Pandemie beeinflusst das Leben von Patient*innen mit chronisch-entzündlichen Darmerkrankungen (CED) in erheblicher Weise. Betroffene und Angehörige haben zahlreiche Fragen zum Erkrankungsrisiko, zum Verlauf einer möglichen SARS-CoV-2-Infektion oder auch zum Einfluss der CED-spezifischen Therapie. Auch bestehen bei vielen CED-Patient*innen zusätzliche Fragen zu Sicherheit und Wirksamkeit einer Impfung gegen SARS-CoV-2. Ziel dieser Übersicht ist die Zusammenfassung der neusten Erkenntnisse zu COVID-19 und CED, aber auch die Diskussion zum Impfansprechen (humoral/zellulär), zum Einfluss laufender Therapie auf die Impfantwort sowie zur Häufigkeit von Nebenwirkungen und zur Bedeutung der Booster-Immunisierungen zu führen und für das Gespräch mit Patient*innen eine Evidenz-basierte Grundlage zu schaffen.

Abstract

The COVID-19 pandemic is significantly affecting the lives of patients with inflammatory bowel disease (IBD). Those affected and their relatives have numerous questions about the risk of the disease, the course of a possible SARS-CoV-2 infection or the influence of CED-specific therapy on these. Many IBD patients also have additional questions about the safety and effectiveness of a vaccination against SARS-CoV-2. The aim of this review is to summarize the latest findings on COVID-19 and IBD, but also to discuss vaccine response (humoral/cellular), the influence of ongoing therapy on the vaccine response as well as the frequency of side effects and the importance of booster immunizations and to create an evidence-based basis for discussion with patients.

Schlüsselwörter

SARS-CoV-2 - COVID-19 - chronisch entzündliche Darmerkrankungen - Morbus Crohn - Colitis ulcerosa - Immunsuppression - Impfung

Keywords

SARS-CoV-2 - COVID-19 - inflammatory bowel diseases - Crohn's disease - ulcerative colitis - immunosuppression - vaccination

Publication History

Received: 26 October 2021

Accepted after revision: 14 January 2022

Article published online:
11 February 2022

• Referenzen

• 1 Grunert PC, Reuken PA, Stallhofer J. et al. Inflammatory Bowel Disease in the COVID-19 Pandemic – the Patients' Perspective. Journal of Crohn's & colitis 2020; DOI: 10.1093/ecco-jcc/jjaa126. (PMID: 32564068)
• 2 Reinsch S, Stallmach A, Grunert PC. The COVID-19 Pandemic: Fears and Overprotection in Pediatric Patients with Inflammatory Bowel Disease and Their Families. Pediatr Gastroenterol Hepatol Nutr 2021; 24: 65-74 DOI: 10.5223/pghn.2021.24.1.65. (PMID: 33505895)
• 3 Walldorf J, von Arnim U, Schmelz R. et al. SARS-CoV-2 Vaccination in Patients With Inflammatory Bowel Disease-Fear and Desire. Inflammatory bowel diseases 2021; DOI: 10.1093/ibd/izab150.
• 4 Neurath MF. COVID-19 and immunomodulation in IBD. Gut 2020; 69: 1335-1342 DOI: 10.1136/gutjnl-2020-321269. (PMID: 32303609)
• 5 Dvornikova KA, Bystrova EY, Churilov LP. et al. Pathogenesis of the inflammatory bowel disease in context of SARS-COV-2 infection. Molecular biology reports 2021; 48: 5745-5758 DOI: 10.1007/s11033-021-06565-w. (PMID: 34296352)
• 6 Vigano C, Mulinacci G, Palermo A. et al. Impact of COVID-19 on inflammatory bowel disease practice and perspectives for the future. World journal of gastroenterology 2021; 27: 5520-5535 DOI: 10.3748/wjg.v27.i33.5520. (PMID: 34588749)
• 7 Tinsley A, Navabi S, Williams ED. et al. Increased Risk of Influenza and Influenza-Related Complications Among 140480 Patients With Inflammatory Bowel Disease. Inflammatory bowel diseases 2019; 25: 369-376 DOI: 10.1093/ibd/izy243. (PMID: 30020478)
• 8 Ko MK, Ng SC, Mak LY. et al. Infection-related hospitalizations in the first year after inflammatory bowel disease diagnosis. Journal of digestive diseases 2016; 17: 610-617 DOI: 10.1111/1751-2980.12397. (PMID: 27533786)
• 9 Mao R, Liang J, Shen J. et al. Implications of COVID-19 for patients with pre-existing digestive diseases. The lancet Gastroenterology & hepatology 2020; 5: 425-427 DOI: 10.1016/S2468-1253(20)30076-5. (PMID: 32171057)
• 10 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: 371-372 DOI: 10.1053/j.gastro.2020.03.062. (PMID: 32247695)
• 11 Taxonera C, Sagastagoitia I, Alba C. et al. 2019 novel coronavirus disease (COVID-19) in patients with inflammatory bowel diseases. Alimentary pharmacology & therapeutics 2020; 52: 276-283 DOI: 10.1111/apt.15804. (PMID: 32359205)
• 12 Allocca M, Chaparro M, Gonzalez HA. et al. Patients with Inflammatory Bowel Disease Are Not at Increased Risk of COVID-19: A Large Multinational Cohort Study. J Clin Med 2020; 9: 3533
• 13 Simon D, Tascilar K, Kronke G. et al. Patients with immune-mediated inflammatory diseases receiving cytokine inhibitors have low prevalence of SARS-CoV-2 seroconversion. Nature communications 2020; 11: 3774 DOI: 10.1038/s41467-020-17703-6. (PMID: 32709909)
• 14 Eder L, Croxford R, Drucker AM. et al. Understanding COVID-19 Risk in Patients with Immune Mediated Inflammatory Diseases: A Population-based analysis of SARS-CoV-2 Testing. Arthritis care & research 2021; DOI: 10.1002/acr.24781.
• 15 Docherty AB, Harrison EM, Green CA. et al. Features of 20133 UK patients in hospital with covid-19 using the ISARIC WHO Clinical Characterisation Protocol: prospective observational cohort study. Bmj 2020; 369: m1985 DOI: 10.1136/bmj.m1985. (PMID: 32444460)
• 16 Chebli JMF, Queiroz NSF, Damiao A. et al. How to manage inflammatory bowel disease during the COVID-19 pandemic: A guide for the practicing clinician. World journal of gastroenterology 2021; 27: 1022-1042 DOI: 10.3748/wjg.v27.i11.1022. (PMID: 33776370)
• 17 Teich N, Ludewig C, Schmelz R. et al. Auswirkungen einer SARS-CoV-2-Infektion auf Symptomatik und Therapie chronisch-entzündlicher Darmerkrankungen. Zeitschrift fur Gastroenterologie 2021; DOI: 10.1055/a-1508-6734.
• 18 Cheung KS, Hung IFN, Chan PPY. et al. Gastrointestinal Manifestations of SARS-CoV-2 Infection and Virus Load in Fecal Samples From a Hong Kong Cohort: Systematic Review and Meta-analysis. Gastroenterology 2020; 159: 81-95 DOI: 10.1053/j.gastro.2020.03.065. (PMID: 32251668)
• 19 Ghimire S, Sharma S, Patel A. et al. Diarrhea Is Associated with Increased Severity of Disease in COVID-19: Systemic Review and Metaanalysis. SN Compr Clin Med 2021; DOI: 10.1007/s42399-020-00662-w:1-8.
• 20 Gadiparthi C, Perisetti A, Sayana H. et al. Gastrointestinal Bleeding in Patients with Severe SARS-CoV-2. The American journal of gastroenterology 2020; 115: 1283-1285 DOI: 10.14309/ajg.0000000000000719. (PMID: 32516204)
• 21 Ricciuto A, Lamb CA, Benchimol EI. et al. Inflammatory Bowel Disease Clinical Activity Is Associated with COVID-19 Severity Especially in Younger Patients. Journal of Crohn's & colitis 2021; DOI: 10.1093/ecco-jcc/jjab172.
• 22 Hasseli R, Mueller-Ladner U, Hoyer BF. et al. Older age, comorbidity, glucocorticoid use and disease activity are risk factors for COVID-19 hospitalisation in patients with inflammatory rheumatic and musculoskeletal diseases. RMD Open 2021; 7: e001464 DOI: 10.1136/rmdopen-2020-001464. (PMID: 33479021)
• 23 Strangfeld A, Schafer M, Gianfrancesco MA. et al. Factors associated with COVID-19-related death in people with rheumatic diseases: results from the COVID-19 Global Rheumatology Alliance physician-reported registry. Annals of the rheumatic diseases 2021; 80: 930-942 DOI: 10.1136/annrheumdis-2020-219498. (PMID: 33504483)
• 24 Lukin DJ, Kumar A, Hajifathalian K. et al. Baseline Disease Activity and Steroid Therapy Stratify Risk of COVID-19 in Patients With Inflammatory Bowel Disease. Gastroenterology 2020; 159: 1541-1544e1542 DOI: 10.1053/j.gastro.2020.05.066. (PMID: 32479824)
• 25 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: 481-491e483 DOI: 10.1053/j.gastro.2021.09.011. (PMID: 34529987)
• 26 Ungaro RC, Brenner EJ, Gearry RB. et al. Effect of IBD medications on COVID-19 outcomes: results from an international registry. Gut 2021; 70: 725-732 DOI: 10.1136/gutjnl-2020-322539. (PMID: 33082265)
• 27 Izadi Z, Brenner EJ, Mahil SK. et al. Association Between Tumor Necrosis Factor Inhibitors and the Risk of Hospitalization or Death Among Patients With Immune-Mediated Inflammatory Disease and COVID-19. JAMA Netw Open 2021; 4: e2129639 DOI: 10.1001/jamanetworkopen.2021.29639. (PMID: 34661663)
• 28 Group RC, Horby P, Lim WS. et al. Dexamethasone in Hospitalized Patients with COVID-19. The New England journal of medicine 2021; 384: 693-704
• 29 Gupta S, Padappayil RP, Bansal A. et al. Tocilizumab in patients hospitalized with COVID-19 pneumonia: systematic review and meta-analysis of randomized controlled trials. J Investig Med 2021; DOI: 10.1136/jim-2021-002001.
• 30 Stallmach A, Kortgen A, Gonnert F. et al. Infliximab against severe COVID-19-induced cytokine storm syndrome with organ failure-a cautionary case series. Critical care 2020; 24: 444
• 31 Reuken PA, Ruthrich MM, Hochhaus A. et al. The impact of specific cytokine directed treatment on severe COVID-19. Leukemia 2021; DOI: 10.1038/s41375-021-01411-1. (PMID: 34493799)
• 32 Melmed GY, Agarwal N, Frenck RW. et al. Immunosuppression impairs response to pneumococcal polysaccharide vaccination in patients with inflammatory bowel disease. The American journal of gastroenterology 2010; 105: 148-154 DOI: 10.1038/ajg.2009.523. (PMID: 19755964)
• 33 Pratt Jr PK, David N, Weber HC. et al. Antibody Response to Hepatitis B Virus Vaccine is Impaired in Patients With Inflammatory Bowel Disease on Infliximab Therapy. Inflammatory bowel diseases 2018; 24: 380-386 DOI: 10.1093/ibd/izx001. (PMID: 29361083)
• 34 Caldera F, Hillman L, Saha S. et al. Immunogenicity of High Dose Influenza Vaccine for Patients with Inflammatory Bowel Disease on Anti-TNF Monotherapy: A Randomized Clinical Trial. Inflammatory bowel diseases 2020; 26: 593-602 DOI: 10.1093/ibd/izz164. (PMID: 31504526)
• 35 Wyant T, Leach T, Sankoh S. et al. Vedolizumab affects antibody responses to immunisation selectively in the gastrointestinal tract: randomised controlled trial results. Gut 2015; 64: 77-83 DOI: 10.1136/gutjnl-2014-307127. (PMID: 24763133)
• 36 Kennedy NA, Lin S, Goodhand JR. et al. Infliximab is associated with attenuated immunogenicity to BNT162b2 and ChAdOx1 nCoV-19 SARS-CoV-2 vaccines in patients with IBD. Gut 2021; 70: 1884-1893 DOI: 10.1136/gutjnl-2021-324789. (PMID: 33903149)
• 37 Reuken PA, Andreas N, Grunert PC. et al. T cell response after SARS-CoV-2 vaccination in immunocompromised patients with inflammatory bowel disease. Journal of Crohn's & colitis 2021; DOI: 10.1093/ecco-jcc/jjab147.
• 38 Watad A, De Marco G, Mahajna H. et al. Immune-Mediated Disease Flares or New-Onset Disease in 27 Subjects Following mRNA/DNA SARS-CoV-2 Vaccination. Vaccines (Basel) 2021; 9: 435 DOI: 10.3390/vaccines9050435. (PMID: 33946748)
• 39 Sangha M, Roitman I, Sultan K. et al. SARS-CoV-2 Immunization in Patients With Inflammatory Bowel Disease May Result in Disease Flares. The American journal of gastroenterology 2021; DOI: 10.14309/ajg.0000000000001416.
• 40 Carr EJ, Kronbichler A, Graham-Brown M. et al. Review of Early Immune Response to SARS-CoV-2 Vaccination Among Patients With CKD. Kidney Int Rep 2021; 6: 2292-2304 DOI: 10.1016/j.ekir.2021.06.027. (PMID: 34250319)
• 41 Stallmach A, Carstens O. Role of infections in the manifestation or reactivation of inflammatory bowel diseases. Inflammatory bowel diseases 2002; 8: 213-218 DOI: 10.1097/00054725-200205000-00009. (PMID: 11979143)
• 42 Senthamizhselvan K, Ramalingam R, Mohan P. et al. De Novo Crohn's Disease Triggered After COVID-19: Is COVID-19 More Than an Infectious Disease?. ACG Case Rep J 2021; 8: e00652 DOI: 10.14309/crj.0000000000000652. (PMID: 34476279)
• 43 Elkharsawi AR, Schmelz R, Stallmach A. et al. Auswirkungen einer SARS-CoV-2-Infektion auf Symptomatik und Therapie chronisch-entzündlicher Darmerkrankungen. Zeitschrift für Gastroenterologie 2022; 60: 77-80 DOI: 10.1055/a-1710-3861.
• 44 Piovani D, Danese S, Peyrin-Biroulet L. et al. Environmental Risk Factors for Inflammatory Bowel Diseases: An Umbrella Review of Meta-analyses. Gastroenterology 2019; 157: 647-659e644 DOI: 10.1053/j.gastro.2019.04.016. (PMID: 31014995)
• 45 Sattui SE, Liew JW, Kennedy K. et al. Early experience of COVID-19 vaccination in adults with systemic rheumatic diseases: results from the COVID-19 Global Rheumatology Alliance Vaccine Survey. RMD Open 2021; 7: e001814 DOI: 10.1136/rmdopen-2021-001814. (PMID: 34493645)
• 46 Geisen UM, Berner DK, Tran F. et al. Immunogenicity and safety of anti-SARS-CoV-2 mRNA vaccines in patients with chronic inflammatory conditions and 7immunosuppressive therapy in a monocentric cohort. Ann Rheum Dis 2021; 80: 13006-13011
• 47 Selim R, Wellens J, Marlow L. et al. SARS-CoV-2 vaccination uptake by patients with inflammatory bowel disease on biological therapy. The lancet Gastroenterology & hepatology 2021; DOI: 10.1016/S2468-1253(21)00347-2.
• 48 Metz TD, Clifton RG, Hughes BL. et al. Disease Severity and Perinatal Outcomes of Pregnant Patients With Coronavirus Disease 2019 (COVID-19). Obstet Gynecol 2021; 137: 571-580 DOI: 10.1097/AOG.0000000000004339. (PMID: 33560778)
• 49 Allocca M, Chaparro M, Gonzalez HA. et al. Patients with Inflammatory Bowel Disease are not at increased risk of COVID-19: A large multinational cohort study. J Clin Med 2020; 9: 3533
• 50 Ungaro RC, Agrawal M, Brenner EJ. et al. New Gastrointestinal Symptoms Are Common in Inflammatory Bowel Disease Patients With COVID-19: Data From an International Registry. Inflammatory bowel diseases 2021; DOI: 10.1093/ibd/izab184.