COVID-19 in Patients with Inflammatory Bowel Disease: The Israeli Experience

Lev Lichtenstein, Benjamin Koslowsky, Ami Ben Ya’acov, Irit Avni-Biron, Baruch Ovadia, Ofer Ben-Bassat, Timna Naftali, Uri Kopylov, Yael Haberman, Hagar Banai Eran, Rami Eliakim, Adi Lahat-Zok, Ayal Hirsch, Eran Zittan, Nitsan Maharshak, Matti Waterman, Eran Israeli, Idan Goren, Jacob E. Ollech, Henit YanaiBella Ungar, Benjamin Avidan, Dana Ben Hur, Bernardo Melamud, Ori Segol, Zippora Shalem, Iris Dotan, Selwyn H. Odes, Shomron Ben-Horin, Yf’At Snir, Yael Milgrom, Efrat Broide, Eran Goldin, Yulia Ron, Nathaniel Aviv Cohen, Eran Maoz, Maya Zborovsky, Safwat Odeh, Naim Abu Freha, Eyal Shachar, Yehuda Chowers, Tal Engel, Hila Reiss-Mintz, Arie Segal, Adar Zinger, Ariella Bar Gil Shitrit*, Shmuel Delgado

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Background: Crohn’s disease (CD) and ulcerative colitis (UC) are chronic, immune-mediated inflammatory bowel diseases (IBD) affecting millions of people worldwide. IBD therapies, designed for continuous immune suppression, often render patients more susceptible to infections. The effect of the immune suppression on the risk of coronavirus disease-19 (COVID-19) is not fully determined yet. Objective: To describe COVID-19 characteristics and outcomes and to evaluate the association between IBD phenotypes, infection outcomes and immunomodulatory therapies. Methods: In this multi-center study, we prospectively followed IBD patients with proven COVID-19. De-identified data from medical charts were collected including age, gender, IBD type, IBD clinical activity, IBD treatments, comorbidities, symptoms and outcomes of COVID-19. A multivariable regression model was used to examine the effect of immunosuppressant drugs on the risk of infection by COVID-19 and the outcomes. Results: Of 144 IBD patients, 104 (72%) were CD and 40 (28%) were UC. Mean age was 32.2 ± 12.6 years. No mortalities were reported. In total, 94 patients (65.3%) received biologic therapy. Of them, 51 (54%) at escalated doses, 10 (11%) in combination with immunomodulators and 9 (10%) with concomitant corticosteroids. Disease location, behavior and activity did not correlate with the severity of COVID-19. Biologics as monotherapy or with immunomodulators or corticosteroids were not associated with more severe infection. On the contrary, patients receiving biologics had significantly milder infection course (p = 0.001) and were less likely to be hospitalized (p = 0.001). Treatment was postponed in 34.7% of patients until recovery from COVID-19, without consequent exacerbation. Conclusion: We did not witness aggravated COVID-19 outcomes in patients with IBD. Patients treated with biologics had a favorable outcome.

Original languageEnglish
Article number376
Issue number3
StatePublished - Mar 2022


FundersFunder number
Altman Research
Given Imaging
Gilead Sciences
Takeda Pharmaceutical Company
Janssen Pharmaceuticals
Ferring Pharmaceuticals


    • Biological drugs
    • COVID-19
    • Crohn’s disease
    • Immune suppression
    • Inflammatory bowel disease
    • Ulcerative colitis


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