A recent study conducted in Italy, the second epicentre for COVID-19, found patients with Inflammatory Bowel Disease (IBD) undergoing biologic treatment to be asymptomatic following SARS-CoV-2 infection, exploring the possibility of intra-hospital spread and confirming that immunosuppressive treatment does not impact disease outcome.

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Bergamo in Italy’s Lombardy region reported a maximum number of COVID-19 patients, turning it into the second biggest epicentre of the pandemic after China. Serology screening data released by the Italian government revealed 24% prevalence in general population, however, that in patients of Inflammatory Bowel Disease (IBD) was not known.

Some reports suggested that the province also had a large number of IBD patients, who had tested positive for the infection but were asymptomatic. They were simultaneously under biologic therapy, which involved the use of Infliximab, Adalimumab, Golimumab, Ustekinumab and/or Vedolizumab, during the COVID-19 outbreak. This meant that their visits to hospitals for their scheduled biologic treatment could cause an intra-hospital spread of the virus. Also, to what extent were these patients exposed to the virus was not clear.

This gave researchers Norsa L, Cosimo P, Indriolo A, et al. an objective to conduct a study – to evaluate the seroprevalance of COVID-19 in IBD patients. Titled ‘Asymptomatic SARS-CoV-2 infection in patients with inflammatory bowel disease under biologic treatment’, the study was published on the Gastro journal website. [1]. The study was hence conducted to assess the seroprevalance of SARS-COV-2 infection in a set of patients from a hospital in Italy’s Bergamo. This article points out the important observations and serology-related findings from the study, which was published in the Gastro Journal in August 2020.

The researchers chose a cohort of infected IBD patients at The Hospital Papa Giovanni XXIII in Bergamo. The hospital was already a centre for COVID-19 care and had over 1500 admissions in the early phase of the pandemic. They studied all IBD patients, including children and adults, being treated at the hospital to figure out the rate of exposure and identify the risk factors they faced.

The enrolment of IBD patients was done between the first lockdown, between 4th March and 3rd May, and the second phase, which was from 4th May to 10th July. The patients were advised to continue with their prescribed treatment during the lockdown and were screened for SARS-CoV-2 infection in case they reported unusual symptoms or had come in contact with COVID-19-positive patients. In the second phase, all patients were offered to undergo a rapid serological test.

Serology-specific evaluation

• All 103 IBD patients reported mild to no COVID-19 symptoms and neither required hospitalisation
• The serologic test was performed on 90 patients, of which, 19 were positive for IgG, IgM or both; this resulted in a SARS-COV-2 seroprevalance of 21%
• 25% of adult IBD patients on biologics were exposed to infection
• Univariate analysis showed an increased positive serology rate in females of older age, which was linked to the reported symptoms
• The multivariate evaluation demonstrated a 5-fold increased risk of positive serology among older males as compared to younger males
• Paediatric cases did not show positivity
• 11 patients with positive serology had no symptoms to report
• Two patients with persistent fever and serology-positivity were made to undergo chest-computed tomography to identify any pulmonary impact. However, the impact was negative.