Crohn’s, Colitis and Covid-19 – latest research

19th May 2020

Most people with Crohn’s and Colitis are not at greater risk of COVID-19 – says latest research. 

Efforts are underway to better understand if commonly used medications for Crohn’s and Colitis alter the risk of complications of COVID-19. Irish investigators from St. Vincent’s University Hospital are working as part of a global research study called SECURE-IBD (https://covidibd.org/) to understand how the disease impacts Crohn’s and Colitis patients. Information on over 1,000 patients with Crohn’s and Colitis who have been diagnosed with COVID-19 has already been analysed and the results to date provide some initial reassurance – with little evidence to show that patients with IBD are at greater risk of contracting COVID-19.

World IBD Day highlights the importance of these chronic diseases like Crohn’s and Colitis and the efforts to improve their treatment using clinical trials. This year, there is cause to pause and reflect on the additional challenge for many patients of all ages with Crohn’s and Colitis who are cocooning due to the medications they are taking. Immunosuppressants are medications which suppress disease related inflammation but may also alter the ability to fight infections. Further research to understand how Crohn’s and Colitis treatments impact how the immune system reacts to COVID-19 are underway and plans to research how these treatments alter response to vaccination are also commencing.

Professor Glen Doherty, Consultant Gastroenterologist at St. Vincent’s University Hospital said: “The initial results of this study are really promising as they show that people living with Crohn’s and Colitis are mostly not at greater risk of complications of COVID-19 and may not be as vulnerable a group as we initially feared.

“Crohn’s and Colitis are becoming much more common in our population. The number of new cases diagnosed each year has tripled in the last 10 years. It is estimated that currently 0.5% of the population suffer with Ulcerative Colitis (UC) and 0.3% of people with Crohn’s. This translates to 40,000 patients in Ireland living with these diseases but most don’t like to talk about it because of the embarrassing nature of the symptoms.” Doherty said “Continued research and on-going clinical trials are essential so we can find new treatments for the increasing number of people living with this disease.”

Key Facts about IBD (Crohn’s and Colitis)

• Ulcerative colitis and Crohn’s disease are the two main types of what is collectively known as IBD (inflammatory bowel disease) – sometimes called ‘Crohn’s and Colitis’ for short.
• These diseases are very distinct from IBS – ‘irritable bowel’. What makes Crohn’s and Colitis different is the presence of chronic inflammation in the gut which can lead to gut damage and even cancer.
• Crohn’s and Colitis patients require long term drug therapies many of which suppress the immune system making them more prone to (sometimes serious) infections.
• People with Crohn’s and Colitis frequently require hospitalisation and/or surgery due to their condition. The diseases most commonly arise in young adults and impact of their ability to work and study, to form relationships and to have children.

The Irish Society for Crohn’s and Colitis (ISCC – www.iscc.ie), the national patient organisation has been working with the Irish Society of Gastroenterology (ISG – www.isge.ie), the body which represents health professionals in this area, to highlight these diseases. Particular aspects that they are currently seeking to bring to the attention of the public and their representatives include;

Key issues for people living with Crohn’s and Colitis

1. Long waits to get the initial diagnosis (particularly waiting for many months to have a colonoscopy)
2. The impact of Crohn’s and Colitis on school and work attendance which costs the individual and society
3. Costs of long term drugs therapy (Crohn’s and Colitis are not covered by the long-term illness scheme)
4. Poor access to specialist care around the country – there is a lack of gastroenterologists and specialist nurses
5. Patients are afraid to attend Hospital Emergency Departments, they especially fear lack of ready access to toilets.

Clinical Trials and Research in IBD (Crohn’s and Colitis)

In order to improve outcomes for patients living with Crohn’s and Colitis, an investigator network to support research in inflammatory bowel disease in Ireland was formed in 2015. The network is called INITIative and it involves over twenty specialist adult and paediatric gastroenterologists from all around the country. The network is involved in a number of important studies and has a website (www.initiativeibd.ie) which aims to improve patient understanding of what clinical trials involve.

1. The network allows better access to drug that are in development by allowing Irish hospitals to take part in large international studies of new drug treatments and new surgical procedures for Crohn’s and colitis. It should also help improve how future studies are conducted by giving a voice to the physicians ‘at the coalface’ looking after Irish patients; for example there is an increasing recognition that it is unfair to ask patients to take only a placebo treatment in a trial if their disease is active
2. INITIative is involved in studies to improve our understanding of the long term safety of existing drugs for Crohn’s and Colitis. ICARE is the largest ever European study of Crohn’s and Colitis patients and will involve over 10,000 patients around Europe including 500 patients from Ireland. Almost 400 patients from Ireland have been enrolled and are participating by filling in a monthly online questionnaire about their health and treatment
3. In response to feedback from special patient focus groups we have conducted, the network has identified that trials of non-drug treatments such as diets and nutritional supplements for Crohn’s and Colitis are urgently required and need to be funded. More studies to look at managing stress as a factor in IBD are also envisaged. We recognize that given that these are chronic, potentially lifelong illnesses, patients need to be involved in setting the agenda for which research questions are important.

Professor Glen Doherty, who leads the INITIative network, is available for interview. He is a UCD Clinical Professor at the School of Medicine, University College Dublin and a Consultant Gastroenterologist at The Centre for Colorectal Disease, St. Vincent’s University Hospital, Dublin

e-mail – glen.doherty@ucd.ie
twitter – @ccddublin
website – www.colorectal.ie , www.initiativeibd.ie