The aftermath of COVID-19: Has the pandemic impaired the health-related quality of life of patients with aggressive inflammatory bowel disease?

Introduction
While the COVID-19 pandemic disrupted everyday life for all individuals, its impact was especially pronounced in patients with chronic illnesses. Among them, individuals undergoing biological therapy experienced additional difficulties related to continuity of care and access to medical professionals.

Aim
We aimed to evaluate the health-related quality of life (HRQoL) in inflammatory bowel disease (IBD) patients, who were receiving biological therapy, before and during the COVID-19 pandemic.

Material and methods
To our knowledge, this is the first study in the Balkans to examine the HRQoL exclusively in IBD patients treated with intravenous biological therapy, in the context of the COVID-19 epidemic. The cross-sectional study was conducted in two acts; in 2019 and during the second wave of the COVID-19 pandemic in 2020. All examinees filled out the short quality of life questionnaire. Patients were assessed for clinical disease activity using clinical activity indices. Also, they completed a questionnaire for the presence of depression – the Patient Health Questionnaire.

Results
There were 90 patients in the group before the pandemic, and 94 IBD patients were examined during the pandemic. The proportion of patients with a poorer HRQoL increased during the pandemic (16.7% vs. 26.6%), but not statistically significantly (p = 0.103). The greatest impact on HRQoL in multivariate analysis both before and during the COVID-19 outbreak was shown by disease activity (p = 0.014; p = 0.023) and the presence of depressive symptoms (p = 0.001; p = 0.002). The percentage of employed IBD patients decreased significantly during the pandemic (from 64.4% before the pandemic to 47.9%; p = 0.024).

Conclusions
An active disease and the presence of depressive symptoms had the greatest impact on impairment of the HRQoL of IBD patients, regardless of the pandemic. Mental health should be given more comprehensive attention in these patients.