Most Read Articles
Pearl Toh, 22 Oct 2020
The combination therapy comprising carfilzomib, cyclophosphamide and dexamethasone (KCd) is effective, with a tolerable safety profile, in an Asian cohort with high-risk multiple myeloma (MM) — thus providing a more economical alternative as a potential upfront regimen in resource-limited settings, according to leading experts during a myeloma education webinar.
Roshini Claire Anthony, 13 Nov 2020

Diabetes is a key risk factor for heart failure (HF), which is the leading cause of hospitalization in patients with or without diabetes. SGLT-2* inhibitors (SGLT-2is) have been shown to reduce the risk of hospitalization for HF (HHF) regardless of the presence or absence of diabetes.

Pearl Toh, 6 days ago
Inhaled corticosteroid (ICS) should be the mainstay of long-term asthma management — such is the key message of the latest Singapore ACE* Clinical Guidance (ACG) for asthma, released in October 2020.
Elvira Manzano, 17 Nov 2020
Invasive fungal infections, particularly those caused by Candida species, are common in hospitalized, immunocompromised, or critically ill patients and are associated with considerable morbidity and mortality.

TNF antagonists safe for IBD patients with COVID-19

Tristan Manalac
25 Aug 2020

The use of tumour necrosis factor (TNF) antagonists does not lead to a worse prognosis in patients with coronavirus disease 2019 (COVID-19), according to a new study. Systemic corticosteroids, on the other hand, appear to be a significant risk factor for severe disease.

“Given the expanding knowledge that persons with comorbidities are disproportionately affected by COVID-19, there is an urgent need to evaluate this emerging infection on patients with systemic, autoinflammatory conditions such as inflammatory bowel disease (IBD), many of whom are treated with immunosuppressive medications,” researchers said.

Of the 525 enrolled COVID-19 patients (median age, 41 years; 52.6 percent male) with IBD, most had Crohn’s disease (59.4 percent), and IBD was in remission in 58.9 percent. Almost half (43.4 percent) of the participants were on TNF antagonist medication, and majority (63.4 percent) had no other comorbidity outside IBD. [Gastroenterology 2020;159:481-491.e3]

Thirty-one percent of the patients needed to be hospitalized, and five percent were admitted to intensive care unit (ICU). Twenty-one required mechanical ventilation, and 16 died. The primary outcome of a composite of death, need for ventilation, and ICU admission was reported in 37 patients, yielding a rate of 7 percent.

Older patients sustained worse outcomes than their younger counterparts. All cases of the primary outcome were in patients ≥60 years of age, and none occurred in paediatric participants. Only three youths (aged <20 years) had to be admitted, and none needed ventilation or intensive care. Nine patients on systemic corticosteroids also developed the composite outcome.

Multivariable analyses confirmed these interactions. For instance, increasing age carried a significantly greater risk of the primary outcome (adjust odds ratio [OR], 1.04, 95 percent confidence interval [CI], 1.01–1.06), as did having two or more comorbidities (adjusted OR, 2.9, 95 percent CI, 1.1–7.8).

Notably, the use of systemic corticosteroids (adjusted OR, 6.9, 95 percent CI, 2.3–20.5) and 5-aminosalicylate (ASA)/sulfasalazine (adjusted OR, 3.1, 95 percent CI, 1.3–7.7) likewise significantly raised the likelihood of the primary outcome. No such effect was reported for the use of TNF antagonists (adjusted OR, 0.9, 95 percent CI, 0.4–2.2).

However, in subsequent exploratory analyses, TNF antagonist combination therapy, as opposed to monotherapy, increased the likelihood of hospitalization or death (adjusted OR, 5.0, 95 percent CI, 2.0–12.3).

“As TNF antagonists are the most commonly prescribed biologic therapy for patients with IBD, these initial findings should be reassuring to the large number of patients receiving TNF antagonist therapy and support their continued use during this current pandemic,” the researchers said.

“Furthermore, in a direct comparison, we observed that 5-ASA/sulfasalazine-treated patients fared worse than those treated with TNF inhibitors,” they added. “Although we cannot exclude unmeasured confounding, further exploration of biological mechanisms is warranted.”

Digital Edition
Asia's trusted medical magazine for healthcare professionals. Get your MIMS Doctor - Malaysia digital copy today!
Sign In To Download
Editor's Recommendations
Most Read Articles
Pearl Toh, 22 Oct 2020
The combination therapy comprising carfilzomib, cyclophosphamide and dexamethasone (KCd) is effective, with a tolerable safety profile, in an Asian cohort with high-risk multiple myeloma (MM) — thus providing a more economical alternative as a potential upfront regimen in resource-limited settings, according to leading experts during a myeloma education webinar.
Roshini Claire Anthony, 13 Nov 2020

Diabetes is a key risk factor for heart failure (HF), which is the leading cause of hospitalization in patients with or without diabetes. SGLT-2* inhibitors (SGLT-2is) have been shown to reduce the risk of hospitalization for HF (HHF) regardless of the presence or absence of diabetes.

Pearl Toh, 6 days ago
Inhaled corticosteroid (ICS) should be the mainstay of long-term asthma management — such is the key message of the latest Singapore ACE* Clinical Guidance (ACG) for asthma, released in October 2020.
Elvira Manzano, 17 Nov 2020
Invasive fungal infections, particularly those caused by Candida species, are common in hospitalized, immunocompromised, or critically ill patients and are associated with considerable morbidity and mortality.