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Mesalamine and Covid

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Ulcerative Colitis
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Posted 4/25/2020 8:32 PM (GMT 0)
I was looking at the data on this website, https://covidibd.org/current-data/, and was surprised to see that Mesalamine / 5-ASA seems to put people at relatively high risk of hospitalization and death due to Covid. Nearly 50 percent of patients on mesalamine needed hospitalization, and 8 percent died. This was a surprising number to me, given that anything I've read about the risks of ibd and covid tend to highlight the fact that prednisone and the immune suppressing drugs put a person at risk, and mesalamine doesn't fall into this category.

But if you look on the ibd /covid site, the case summary clearly shows that after prednisone, mesalamine had the highest incidence of hospitalization and death out of all the ibd meds.

Does anyone have any thoughts on this? I realize it is a relatively small sample size, but I find these numbers concerning, especially considering that the general advice that's out there is that mesalamine is not a risk factor for increased covid complications.
Posted 4/25/2020 11:57 PM (GMT 0)
It's a curious thing, noticed it myself and have no explanation for it.

Best guess. I know some of the UC biologics (humira, xeljanz, stelara to name several) are being studied as a treatment for Corvid19 due to their immunosuppressive affect. Those who die of corvid19 are often killed by a cytokine storm created by their immune system. The biologics mentioned interfere with the immune system's ability to create such a cytokine storm. So the biologic might fight that storm and be protective.

Mesalamine is topical and does not help or hurt the lungs where this infection affects us.
Posted 4/26/2020 7:11 AM (GMT 0)
My thoughts: The 5-ASA meds can be dehydrating. COVID-19 can cause high fever, which is dehydrating. Therefore, UCers may develop a need for IV-fluid administration and therefore, hospitalization, if they have continuing fever that makes oral hydration inadequate. Or nausea/vomiting from the virus could also enter the picture. In addition, more UCers overall take steroids or 5-ASA meds than biologics, as far as I know, which would likely skew some of the statistics to make it seem like 5-ASAs are more dangerous in case of COVID attack than immunosuppressants. From what I've read to-date IBDers are more endangered with regard to COVID-19 by not being in remission and/or being deficient in vitamins/minerals longterm that weaken their immune system response, or by being on high dose steroids at length than by taking mesalamine meds properly. / Old Hat (39 years with left-sided UC; presently in remission taking brandname Colazal)
Posted 4/26/2020 7:59 AM (GMT 0)
It's a misleading representation of the data which unfortunately happens because of the way they publish the statistics.

This really annoys me to be honest.

Covidibd.org only publishes the worst cases, i.e. those with symptoms severe enough to warrant testing.

In the early days they used to publish the details of the fatalities, but now they stopped that.

When you could see that, the mesalazine fatalities were unanimously over 70.

It's not the mesalazine that kills them. Its their age or comorbidities. The patients taking mesalazine in this database have an age demographic skewed towards the elderly.

Elderly ibd patients tend not to use immunumodulators so often as younger patients, because it is less safe for them to do so, and if they had more severe cases in their earlier years they would have been pre biologics and gone for colectomy.

So keep taking your mesalazine and don't worry about misleading statistics.
Posted 4/26/2020 9:05 AM (GMT 0)
I believe the data collected for this site is self reported by doctors (who are aware the site exists). It is not randomized in any way that I can tell from quickly reading. A doctor is not going to bother entering information on mild cases and the self-selecting nature of the data collection makes it pretty useless from my (lay person's) perspective. I don't know how doctors are made aware of this site's existence.
Posted 4/26/2020 10:16 AM (GMT 0)
There are probably (e)mailing lists among the ibd medical community which can inform doctors about the website (at least that's how it works in my field of research). However in many countries mild cases are not tested (nor asymptomatic cases, for obvious reasons), and I can imagine if I was on mesalazine and in remission, I wouldn't even bother my ibd doctor if I came down with a mild case of coronavirus.
Posted 4/26/2020 4:42 PM (GMT 0)
What poopydoop said. I also wonder if they looked at confounding factors, like the effects of other drugs they were also taking and of course known risk factors like age, high blood pressure, heart disease and diabetes.
Posted 4/27/2020 1:55 PM (GMT 0)
Seems prone to bias. For example, if a prominent physician suggests mesalamine may be a risk factor, other doctors will be more likely to confirm that hypothesis.
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