IMPACT OF COVID-19 ON THE CLINICAL OUTCOMES AND MANAGEMENT OF IGG4 RELATED DISEASE PATIENTS WITH PANCREATOBILIARY INVOLVEMENT: A MULTICENTER RETROSPECTIVE STUDY

Background: Coronavirus disease 2019 has affected more than 249 million people worldwide as of November 2021.Patients with chronic immune-mediated inflammatory diseases are at risk of viral infections either related to their underlying immune dysfunction or the immunosuppressive therapy, but little is known about the impact of COVID-19 on outcomes and management of pancreatobiliary IgG4 related disease (IgG4 RD) patients.Methods: This was a multicenter retrospective cohort study aiming to investigate the impact of COVID-19 on the clinical outcomes and management of pancreatobiliary IgG4 RD patients in different geographic areas with COVID-19 outbreak.Pancreatobiliary IgG4 RD patients aged 18 years or older from 7 referral centers in Hong Kong, Japan, Thailand, Singapore, the United States and Italy were included.Case definition of IgG4 RD: elevated serum IgG4 serology with typical features of pancreatobiliary involvement on imaging, EUS, ERCP and/ or typical histopathologic features of IgG4 RD.Medical records were reviewed for IgG4 RD status (organ involvement, disease activity, treatment status), COVID-19 infection and outcome.Outcome measures were incidence and severity of COVID-19 in pancreatobiliary IgG4 RD patients, medical treatment for the IgG4 disease during COVID-19 and incidence of postponement or discontinuation of indicated medical treatment for IgG4 RD during COVID-19.Results: 101 pancreatobiliary IgG4 RD patients (mean age 66.4 +/-12.1 years, male 74.3%) from 7 referral centers were included from January 2020 to November 2020.Major comorbidities of patients: none in 21.8%, diabetes in 45.5%, hypertension in 49.5%, ischemic heart disease in 8.9%, chronic liver disease in 8.9%, chronic kidney disease in 9.9% and cancer in 5.0% of patients.IgG4 RD organ involvement: pancreas only in 36.6%,pancreas and bile duct in 16.8%, bile duct only in 14.9%, pancreatobiliary and other organs in 26.7% of patients.The mean serum IgG4 serology level was 4.72+/-7.31g/L.In 2020, 27.7% of patients had active IgG4 disease while 72.3% of patients were in remission.In 2020, 65.3% of patients received treatment (steroid in 48.5%, thiopurines in 22.7%, steroid and thiopurines in 25.8%, rituximab in 1.5%), while 30.7% of patients were not on treatment.2 patients (2.0%) had COVID-19 infection, with 1 patient requiring ICU admission.All infected patients recovered from COVID-19 without flare up of IgG4 RD.In 2020, 6.9% of patients had postponement or discontinuation of indicated medical treatment for IgG4 RD during COVID-19 outbreak due to concern of COVID-19 infection while on immunosuppressive therapy.Conclusion: In this study, low incidence of COVID-19 infection and low rates of postponement or discontinuation of indicated medical treatment were observed in pancreatobiliary IgG4 RD patients during COVID-19 outbreak in 2020.