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Lookup NU author(s): Professor Chris LambORCiD
This is the of an article that has been published in its final definitive form by John Wiley and Sons Inc, 2022.
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© 2022 John Wiley & Sons Ltd.Background: The COVID-19 pandemic offered a unique opportunity to understand inflammatory bowel disease (IBD) management during unexpected disruption. This could help to guide practice overall. Aims: To compare prescribing behaviour for IBD flares and outcomes during the early pandemic with pre-pandemic findings. Methods: We performed an observational cohort study comprising patients who contacted IBD teams for symptomatic flares between March and June 2020 in 60 National Health Service trusts in the United Kingdom. Data were compared with a pre-pandemic cohort after propensity-matching for age and physician global assessment of disease activity. Results: We included 1864 patients in each of the pandemic and pre-pandemic cohorts. The principal findings were reduced systemic corticosteroid prescription during the pandemic in Crohn's disease (prednisolone: pandemic 26.5% vs. 37.1%; p < 0.001) and ulcerative colitis (UC) (prednisolone: pandemic 33.5% vs. 40.7%, p < 0.001), with increases in poorly bioavailable oral corticosteroids in Crohn's (pandemic 15.6% vs. 6.8%; p < 0.001) and UC (pandemic 11.8% vs. 5.2%; p < 0.001). Ustekinumab (Crohn's and UC) and vedolizumab (UC) treatment also significantly increased. Three-month steroid-free remission in each period was similar in Crohn's (pandemic 28.4% vs. 32.1%; p = 0.17) and UC (pandemic 36.4% vs. 40.2%; p = 0.095). Patients experiencing a flare and suspected COVID-19 were more likely to have moderate-to-severely active disease at 3 months than those with a flare alone. Conclusions: Despite treatment adaptations during the pandemic, steroid-free outcomes were comparable with pre-pandemic levels, although concurrent flare and suspected COVID-19 caused worse outcomes. These findings have implications for IBD management during future pandemics and for standard practice.
Author(s): Saifuddin A, Kent AJ, Mehta SJ, Hicks LC, Gonzalez HA, Segal JP, Brookes MJ, Subramanian S, Bhala N, Conley TE, Patel KV, Lamb CA, Walker GJ, Kennedy NA, Sebastian S, Abdale S, Abbesi A, Abusrewil A, Aghimien P, Ahmed S, Ali A, Ali A, Alkhouri J, Allen P, Al-Rifaie A, Appleby R, Arasaradnam R, Arebi N, Arms-Williams B, Ashraf M, Andrea A, Avades T, Ayubi H, Baillie S, Balarajah S, Bancil A, Basit A, Bayati M, Bell A, Berry A, Bhala N, Bhat S, Bhattacharyya J, Bishop S, Blackmore L, Bond A, Borg-Bartolo S, Botwright E, Bouri S, Boyle S, Bradley N, Brailsford F, Brennan E, Britton D, Brooks M, Brown C, Butcher R, Butterworth J, Campbell R, Campbell R, Campbell I, Carr R, Carter J, Cartlidge P, Chandy R, Chatten K, Chaudhary R, Chee D, Chessbrough J, Churchhouse A, Clough J, Cole A, Conley T, Cook J, Cooney R, Cotton S, Critchlow T, Cuison F, Curran C, Darie A-M, Dart R, Davwar P, Dawa KK, Dhar A, Din S, Diong KL, Disney B, Dooks E, Downey L, D'Souza A, Dyall L, Elias M, Felwick R, Finegan M, Flanagan P, Fofaria R, Fong S, Fox R, Fraser A, Frunza C, Ghodeif A, Ghosh N, Gilroy L, Gonzalez HA, Good L, Gordon J, Grasso N, Gueroult A, Gulliver J, Guthrie S, Gwiggner M, Hanna M, Harlow C, Harrison W, Hart A, Hawthorne B, Hicks L, Hooper P, Howard W, Hussain N, Hutton T, Htun AM, Irving P, Jagdish R, Javed A, Javed A, Jayasooriya N, Johnson M, Johnston E, Jones G-R, Kanagasundaram C, Karagkouni F, Kemp K, Kennedy N, Kent A, Khalil H, Khan N, Khan Z, Khasawneh M, King A, Kirkham B, Kirkham F, Kokwaro F, Korani M, Koumoutsos I, Kumar A, Kuzhiyanjal AJK, Lakeland M, Lamb C, Laverick S, Lees C, Levell E, Levison S, Lim S, Lim Y-H, Limdi J, Lindsay J, Lisle J, Lobo A, Luber R, Lucacui L, Lyne H, MacDonald J, Mahalingam A, Mahgoub S, Malakar R, Marley F, Mason J, Masri A, Mazhar Z, McCaughan H, McCort T, McCulloch A, McIlwaine S, Meah N, Mebarek L, Mehta S, Mendall M, Mir N, Moffatt V, Moran G, Morris L, Morrison G, Morrison G, Mulligan R, Murray C, Murray J, Myers S, Naeck-Boolauky P, Naranjo A, Navaratnam J, Naylor D, Nixon E, Nixon K, Nolan J, Olabintan O, San EOM, Owen H, Palmer-Jones C, Patel K, Peddada K, Pee L, Peerally M, Perkins R, Phillips F, Pohl K, Pollok R, Powell N, Qayyum F, Quarashi M, Quraishi MN, Radcliffe E, Radford S, Rahmany S, Ramadan H, Ramadas A, Reddington A, Riggott C, Riley T, Rimmer P, Ritchie S, Rosiou K, Rowland S, Sabine J, Saifuddin A, Sarwar S, Sasegbon A, Saunders J, Sebastian S, Sebepos-Rogers G, Seenan JP, Segal J, Selinger C, Serna S, Sethi S, Shale M, Shenderey R, Shenoy A, Sherifat Y, Sheth R, Siakavellas S, Sikafi R, Singh A, Singh S, Singh U, Sivaji G, Smith P, Speight A, Spence A, Stansfield C, Steed H, Subramanian S, Suseehran K, Tabuso M, Taucius D, Taylor J, Thakor A, Tham T, Townsend G, Townsend T, Troth T, Tunney R, Turner K, Umar N, Vakeeswarasarma V, Verma A, Walker G, Wallace H, Walton H, Wang B, Warner E, Watson C, Wen S, Widlak M, Williams M, Woods A, Younge L, Zafar M
Publication type: Article
Publication status: Published
Journal: Alimentary Pharmacology and Therapeutics
Year: 2022
Volume: 56
Issue: 10
Pages: 1460-1474
Print publication date: 01/11/2022
Online publication date: 05/10/2022
Acceptance date: 05/09/2022
Date deposited: 05/09/2022
ISSN (print): 0269-2813
ISSN (electronic): 1365-2036
Publisher: John Wiley and Sons Inc
URL: https://doi.org/10.1111/apt.17223
DOI: 10.1111/apt.17223
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