Patients With Inflammatory Bowel Disease Not At Higher Risk of COVID-19, Should Continue Therapies

Although patients with inflammatory bowel disease (IBD) have unique concerns during the coronavirus disease 2019 (COVID-19) pandemic, new guidance from the American Gastroenterological Association (AGA) states there is currently no evidence that IBD increases the risk of contracting severe acute respiratory coronavirus-2 (SARS-CoV-2) or developing COVID-19.

The clinical practice update incorporates emerging evidence and available guidance for patients with IBD, according to the association.

IBD includes Crohn disease and ulcerative colitis, which are both characterized by chronic gastrointestinal tract inflammation, according to the CDC. Symptoms include persistent diarrhea, abdominal pain, weight loss, and fatigue.

The exact cause of IBD is unknown, but it has been confirmed to be the result of a defective immune system that responds incorrectly to environmental triggers. According to the CDC, there also appears to be a genetic component.

During the pandemic, patients should continue IBD therapies, including scheduled infusions, according to the AGA recommendations.

For patients with IBD and mild COVID-19 who are not hospitalized and have no evidence of pneumonia, corticosteroids should be tapered or the patient should be switched to budesonide, according to the AGA. Treatments such as 5-ASA, budesonide, rectal therapies, and enteral nutrition can be continued, but thiopurines, methotrexate, and tofacitinib should be stopped.

Biologic medications should be delayed 2 weeks to see whether the infection resolves. If it does not, those medications should continue to be held, according to the AGA recommendations.

For those with moderate or severe COVID-19, most recommendations are the same. However, the recommendations urged the health team to focus on life support and treatment of COVID-19 with anti-inflammatory, anti-cytokine, and/or antiviral therapies.

Therapies can be resumed after COVID-19 symptoms resolve, when the SARS-CoV-2 re-testing is negative, or when entering the convalescent phase of immunity, according to the AGA.

REFERENCE

Rubin DT, Feuerstein JD, Wang AY, Cohen RD, AGA Clinical Practice Update on Management of Inflammatory Bowel Disease During the COVID-19 Pandemic: Expert Commentary. Gastroenterology; April 12, 2020. https://www.gastrojournal.org/article/S0016-5085(20)30482-0/fulltext. Accessed April 15, 2020.