Impact of biologics and small molecules for inflammatory bowel disease on COVID‐19‐related hospitalization and mortality: A systematic review and meta‐analysis

BACKGROUND AND AIM: The use of biologics and small molecules has been a concern for patients with inflammatory bowel disease (IBD) during the COVID‐19 pandemic. We aimed to assess the association between the risk of COVID‐19‐related hospitalization and these agents. METHODS: We made a systematic review and meta‐analysis of all published studies from December 2019 to September 2021 to identify studies that reported COVID‐19‐related hospitalization in IBD patients receiving biologic therapies or tofacitinib. We calculated the risk ratio (RR) to compare the relative risk of COVID‐19‐related hospitalization in patients receiving these medications to those who were not, at the time of the study. RESULTS: Eighteen studies were included. The relative risk of hospitalization was significantly lower in patients with IBD and COVID‐19 who were receiving biologic therapy (RR = 0.47 [95% confidence interval, CI: 0.42–0.52, P < 0.00001]) compared to patients not receiving biologics. The RR was lower in patients receiving anti‐tumor necrosis factors (TNFs) compared to those who were not (RR = 0.48 [95% CI: 0.41–0.55, P < 0.00001]). A similar finding was observed in patients taking ustekinumab (RR = 0.55 [95% CI: 0.43–0.72, P < 0.00001]). Combination therapy involving anti‐TNF and an immunomodulator did not lower the risk of COVID‐19‐related hospitalization (RR = 0.98 [95% CI: 0.82–1.18, P = 0.84]). The use of vedolizumab (RR = 1.13 [95% CI: 0.75–1.73, P = 0.56]) or tofacitinib (RR = 0.81 [95% CI: 0.49–1.33, P = 0.40]) was not associated with a lower risk of COVID‐19‐related hospitalization. CONCLUSION: Regarding COVID‐19‐related hospitalization in IBD, anti‐TNFs and ustekinumab were associated with decreased risk of hospitalization. In addition, vedolizumab and tofacitinib were not associated with COVID‐19‐related hospitalization.