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Dr. Mike Beyak

IBD in the time of COVID-19 – Dr. Michael Beyak

Kassandra, Coyle, MSc'22 Candidate (Translational Medicine)

At the January 21st Medical Grand Rounds, the TMED students had the pleasure and privilege to learn from Dr. Michael Beyak. With a presentation entitled “IBD in the time of COVID-19”, Dr. Beyak presented on the common concerns of IBD patients, the impact and risks of IBD on COVID-19, as well as the concerns and guidelines for the COVID-19 vaccine.
 

Inflammatory bowel disease (IBD) is the umbrella term for several conditions characterized by the inflammation of the gastrointestinal (GI) tract, including Crohn’s Disease and Ulcerative Colitis. A well-justified concern for IBD patients is whether or not they are at a higher risk for developing COVID-19. In addition to being immunocompromised, IBD patients spend significantly more time in potentially high-risk healthcare settings. However, according to the literature, most studies have found that the rate of test positivity is nearly identical, if not decreased in the IBD population compared to the general community (1).
 

The SECURE-IBD database was created to monitor and report outcomes of COVID-19 in the global IBD population. Data generated from this registry has established that disease activity influences COVID-19 outcomes, with an increased risk of a severe outcome in response to active IBD (2). Additional predictors of poor outcomes include age, comorbidities, and the use of certain medications. Some immunosuppressive IBD medications may be associated with severe outcomes, with oral/parental steroids having the highest risk (2). However, stopping medication comes with the risk of disease flare, which impacts COVID-19 susceptibility and may require steroid treatment to get the disease back under control. In his presentation, Dr. Beyak alluded to the fact that most of the treatments prescribed to patients are relatively safe and that patients concerned about their medication should contact their physician with any questions.
 

Many IBD patients have concerns about the COVID-19 vaccine. At this time there isn’t any direct data to address these concerns as patients with autoimmune diseases and those that are immunosuppressed were excluded from vaccine trials. Though we can extrapolate upon data from other vaccinations and their impact on patients (3,4). Many other vaccines do not precipitate flares of IBD and are effective in the immunocompromised population. It is currently recommended that patients with IBD receive the COVID-19 vaccine and consult their physician regarding any concerns.

 

During the post grand round discussion, Dr. Beyak and the TMED students focused on how COVID-19 has affected IBD patients’ lifestyles. The many uncertainties surrounding the pandemic have had a negative impact on the mental health of many patients and has led to increased levels of stress and anxiety. Many ways in which people manage stress involve social interactions and activities that are done outside of the home, both of which have been severely limited. Dr. Beyak highlighted the importance of maintaining some normalcy during the pandemic, encouraging getting outside and exercising as a means of stress management. It is important to maintain relationships with various social supports and find new ways to connect with others. Furthermore, it is important to remember that healthcare is still easily accessible despite the limitations and any concerns should be brought to the attention of your physician.

 

The discussion then transitioned into how this information is presented in the media. Dr. Beyak described the challenges he has faced in keeping up with rapidly changing information. He highlighted the importance of critically evaluating everything you read; just because something has COVID-19 in the title does not make it good information. For patients looking to learn, he suggested starting with well-recognized patient advocacy organizations, such as Crohn’s and Colitis Canada (5).

 

Finally, the TMED students learned about Dr. Beyak’s educational history and his journey to becoming a clinician scientist. Dr. Beyak completed his undergrad at Queen’s University where he began his journey in research under the supervision of his now colleague, Dr. Stephen Vanner. Dr. Beyak went on to complete medical school and residency at the University of Toronto, where he continued to be involved in research training. Currently, Dr. Beyak is embarking on a clinically focused career, while still collaborating with his colleagues in the Gastrointestinal Diseases Research Unit (GIDRU). Throughout his career Dr. Beyak has enjoyed the opportunities to combine his love for teaching and research while also having the opportunity to look after patients.

 

It was a pleasure to hear Dr. Michael Beyak’s presentation on the impact of COVID-19 on IBD. On behalf of the TMED graduate program, I would like to sincerely thank him for his time and expert insight.
 

  1. Gubatan, J. et al. SARS-CoV-2 Testing, Prevalence, and Predictors of COVID-19 in Patients with Inflammatory Bowel Disease in Northern California. Gastroenterology 159, (2020).
  2. Current Summary Data. SECURE-IBD Database (2021). Available at: https://covidibd.org/current-data/. (Accessed: 24th January 2021)
  3. Park, S. H. et al. Efficacy of Hepatitis A Vaccination and Factors Impacting on Seroconversion in Patients with Inflammatory Bowel Disease. Inflammatory Bowel Diseases 20, 69–74 (2014).
  4. Gisbert J. et al. Efficacy of hepatitis B vaccination and revaccination and factors impacting on response in patients with inflammatory bowel disease. American Journal of Gastroenterology 107, (2012).
  5. About Crohn's & Colitis. COVID-19 and IBD - COVID-19 and IBD Available at: https://crohnsandcolitis.ca/About-Crohn-s-Colitis/COVID-19-and-IBD. (Accessed: 24th January 2021)

 

Comments

Name
Max Moloney

Mon, 01/25/2021 - 10:22

Thank you, Kassandra, for your detailed summary of Dr. Beyak’s presentation during Medical Grand Rounds this past Thursday.

I was pleased to learn about the SECURE-IBD database that physicians and experts like Dr. Beyak have access to inform patient care. It is encouraging that during a health care crisis, medical experts from around the world have collaborated to create this important tool to better understand how COVID-19 affects IBD patients. I have found international collaborations, like SECURE-IBD to be a source of hope that we can effectively come together to solve complex global issues. I look forward to following the progress and results from the SECURE-IBD database.

I would also like to thank Dr. Beyak for his candid discussion on his journey to his current role as a clinician-scientist at Queen’s. In conversation, Dr. Beyak was able to provide insight on the benefits and challenges of balancing a clinical and research career; offering guidance to take into consideration as we progress through our graduate programs.

Name
Max Moloney

Name
Caitlyn Vlasschaert

Mon, 01/25/2021 - 12:44

Thank you to Dr. Beyak for the great presentation. It is remarkable how the global IBD research community has collectively monitored IBD patient outcomes throughout the COVID-19 pandemic in order to provide recommendations moving forward. Roughly 6 months into the pandemic, they published a series of papers providing clear guidance in different clinical scenarios (https://academic.oup.com/ecco-jcc/issue/14/Supplement_3). This type of evidence-based guidance can help allay uncertainty and anxiety– both on the part of the patient and the treating clinician– in these evolving times.

Name
Caitlyn Vlasschaert

Thank you Caitlyn for sharing these resources. It is inspiring to see how the global research community has come together to help alleviate some of the uncertainties surrounding these two diseases. I look forward to continue to follow the amazing work that is being done!

Name
Kassandra Coyle

Name
Melinda Chelva

Mon, 01/25/2021 - 12:58

Excellent post Kassandra! You did an amazing job delving deep into the topics Dr. Beyak discussed during the MGR last week!

I really enjoyed the post grand round discussion! I was fascinated to hear about the emerging use of self-injectable medications for Canadians with Ulcerative Colitis and Crohn’s Disease. While I can definitely see these self-administrable treatments being widely accepted by patients during the COVID-19 pandemic as a way to minimize their number of visits to hospitals and clinics, I wonder whether all patients will respond positively to the self-administration of these treatments? In other words, I wonder whether some patients will still prefer health care professionals to administer these treatments instead of themselves? Additionally, I am curious as to whether these methods of drug administration will continue to be used by patients even after the pandemic? And on a separate note- as an alternative to these self-administrable treatments, I also wonder whether there has been thought to change the dosing of “in-person” treatments in order to minimize visits to the hospital and clinic?

Overall, I am very excited to see how the treatment of IBD patients will evolve during and after the COVID-19 pandemic!

Name
Melinda Chelva

Name
Kassandra Coyle

Tue, 01/26/2021 - 12:06

In reply to by Melinda Chelva (not verified)

Thank you Melinda for your response! You bring up an excellent point of discussion. At the end of our talk, Dr. Beyak commented on how he thought the treatment of IBD would change over the next 10 years. He believed that the use of "telephone clinic visits" would continued to be implemented long past the pandemic, to alleviate travel and inconvenience for patients. I believe that there will be a positive response to the self-administration of treatments and we may continue to see an increase in their use, especially once patients are more comfortable with them.

Name
Kassandra Coyle

Name
Jordan Harry

Mon, 01/25/2021 - 14:30

Thank you, Kassandra, for the excellent summary of Dr. Beyak’s presentation and discussion. I was particularly interested in why patients had higher chances of adverse outcomes on oral/parenteral steroids, and sulfasalazine, whereas they had a lower risk of adverse outcomes on some of the most common biologics. I think that Dr. Beyak did an excellent job addressing some plausible mechanisms behind this variance.
Another takeaway from this presentation that resonated with me was the importance of not only keeping up with rapidly changing information about COVID-19, but also implementing it into clinical practice, and then conveying the information to patients and their families. This has become particularly relevant to information about the COVID-19 vaccine.

Name
Jordan Harry

You raise an excellent point Jordan- physicians have been tasked to implement new information about COVID-19, as it changes, to patients and their families. With regards to conveying this information, I am curious as to whether the pandemic has resulted in hospitals and clinics to develop and deliver remote educational initiatives to address any concerns and questions that IBD patients and their families may have?

Name
Melinda Chelva

Name
Jummy Oladipo

Wed, 01/27/2021 - 12:12

Thank you, Kassandra for a great summary of Dr. Beyak’s presentation. Additionally, thank you Dr. Beyak for taking the time to discuss with us how COVID-19 impacts those with IBD. Something that resonated with me from Dr. Beyak’s presentation was the importance of a global effort amidst the pandemic to ensure that the correct information is being communicated to IBD patients regarding COVID-19 and their disease. The SECURE-IBD registry is an effective way to keep clinicians up to date during these rapidly changing times so that the correct information is communicated to their patients. The registry would also be a useful tool to monitor IBD patients’ responses to the COVID-19 vaccine. A similar registry was established to monitor COVID-19 coagulopathy in pregnancy. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7461532/. As a student researcher, it is exciting to see how the research world has come together to investigate COVID-19’s effects on specific populations.

Name
Jummy Oladipo

Name
Michaela Spence

Thu, 01/28/2021 - 10:39

Thank you Kassandra for the excellent summary and to Dr. Beyak for the wonderful and informative presentation at Grand Rounds.

What really stuck with me after the post rounds discussion was how pregnant women or patients with comorbidities such as IBD and diabetes are often excluded from important studies such as vaccination studies. Dr. Bayek mentioned how most of the time these studies are done using the “ideal patient”. It got me thinking as to the relative generalizability of vaccination study results and how important it is to include patients with comorbidities in later studies to determine their safety in the general population. With the COVID vaccine becoming more readily available to the public it is important to educate the public on safety and efficacy of the vaccine in different populations. I hope that studies delving into the safety of the vaccine use in many understudied populations will help to soothe any relative unease many patients with comorbidities have about whether the vaccine is safe and effective for their use.

Name
Michaela Spence

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