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Professor Richard Gearry —

Surveillance Epidemiology of Coronavirus Under Research Exclusion (SECURE-IBD) is an international, paediatric and adult database to monitor and report on outcomes of COVID-19 occurring in IBD patients.

The COVID-19 pandemic has caused unprecedented and rapid effects on the health of the world’s population. This has required researchers to develop novel ways to understand how COVID -19 affects different population groups. SECURE-IBD is an international initiative that enables doctors and nurses to report cases of COVID in IBD patients to a central database. Although there are inevitable biases in such an approach, this has enabled researchers to study the effects of COVID-19 infection in a large number of IBD patients. Summary data from SECURE-IBD is available at www.covidibd.org

There are a number of key findings from SECURE-IBD to date. Firstly, IBD patients who are likely to be affected with more severe COVID are those who are older and with cardiovascular disease (eg diabetes, hypertension etc) or other co-morbidities. With regard to IBD-specific risk factors, being on oral or IV steroids is associated with more severe COVID. Anti-TNF drugs (infliximab and Humira) have not been associated with worse outcomes. There is a signal that immunomodulators such as azathioprine, mercaptopurine and methotrexate either when prescribed alone or in combination with an anti-TNF drug may be associated with worse outcomes in those who are infected with COVID-19. However, it is recommended that IBD patients do not stop immunomodulators or anti-TNF drugs to avoid more severe outcomes from COVID-19 infection. The reason for this is that stopping drugs may lead to a flare of symptoms that will likely require steroids and possibly hospitalisation, both of which would be detrimental if patients develop COVID-19 infection.

Although not specifically addressed by SECURE-IBD, there is overwhelming expert opinion that all IBD patients should be vaccinated against COVID-19 as soon as possible. There is no chance of getting COVID-19 from being vaccinated. It is possible that IBD patients on immunosuppressing drugs may be slower to mount an immune response following vaccination but at this time it appears that the vaccine is effective in IBD patients.

Dr Samantha Benson-Pope, Professor Sarah Hook and Professor Michael Schultz have recently produced a NZ position statement concerning COVID-19 vaccination in NZ IBD patients which can be found here: https://nzsg.org.nz/news-and-events/article/7584

The International Organisation for the study of IBD (IOIBD) has also published its consensus guidance: https://gut.bmj.com/content/gutjnl/early/2021/01/20/gutjnl-2020-324000.full.pdf