Opinion Review
Copyright ©The Author(s) 2020.
World J Gastroenterol. Oct 7, 2020; 26(37): 5534-5542
Published online Oct 7, 2020. doi: 10.3748/wjg.v26.i37.5534
Table 1 Summary of expert opinions and guidelines
OrganizationIBD treatment, stable disease (No known or suspected COVID-19)Known or suspected COVID-19
Chinese IBD SocietyMay continue anti-TNF; May continue vedolizumab; May continue ustekinumab but avoid new IV infusion initiation (to avoid infusion center); Discourage new tofacitinib use in endemic areas; Discourage new or increased dose of immunosuppressant; Postpone elective surgery or endoscopyContact physician for temperature over 38 C; Hold immunosuppressant and biologic agents for suspected COVID-19
SARS-CoV-2 positive testing (without COVID-19 disease)SARS-CoV-2 positive testing (with COVID-19 disease)
IOIBDContinue infusions (if center has COVID-19 testing protocol); Reduce or DC prednisone (but not other therapies); Treat moderate to severe IBD (new or relapsing disease) with same therapies as pre-COVID-19; Postpone elective proceduresUncertain if need to stop anti-TNF; Uncertain if need to stop ustekinumab; Stop tofacitinib; (IBD medications can be restarted after 14 d if the patient has not developed COVID-19)Stop anti-TNF, ustekinumab, tofacitinib; Stop IMM if on combination therapy; Uncertain if need to stop vedolizumab; (IBD medications stopped may be restarted after COVID-19 symptoms resolve and/or after 2 nasopharyngeal PCR tests are negative
AGAContinue current IBD therapies; Continue infusions at appropriate infusion centers; Only perform urgent or emergent proceduresHold thiopurines, methotrexate, and tofacitinib; Delay biologic therapy for 2 wk while monitoring for COVID-19 symptomsHold thiopurines, methotrexate, tofacitinib, and biological therapies; (IBD medications may be restarted after complete symptom resolution or when follow up viral testing is negative or serology demonstrates convalescent stage
Table 2 Continued summary of expert opinions and guidelines
General recommendationsSerious COVID-19 disease risk: Highest riskModerate riskLowest risk
BSGContinue current medications; Avoid corticosteroids if possible Observe “shielding” while prednisone dose ≥ 20 mg daily; Initiation of IMM monotherapy not advised; Consider stopping thiopurines in older patients or those with significant comorbidity who are in sustained remission; Consider monotherapy with anti-TNF; Consider adalimumab over infliximab to promote home care; Early use of therapeutic drug monitoring; Do not recommend switching from IV to S/CIBD and a comorbidity; Hypertension Diabetes; Age ≥ 70 yr; AND one from “Moderate Risk” column OR; Moderate to severely active disease; ≥ 20 mg prednisolone or equivalent; New biologic < 6 wk; Moderate to severely active disease NOT controlled on Moderate risk Rx; Short bowel syndrome ON nutritional support; Requirement for Parenteral nutritionAnti-TNF monotherapy; Biologic plus immunomodulator in stable patients; Ustekinumab; Vedolizumab; Thiopurines; Methotrexate; Calcineurin inhibitors (tacrolimus or ciclosporin); Janus kinase inhibitors (tofacitinib); Immunosuppressive trial medication; Mycophenolate mofetil; Thalidomide; Prednisolone < 20 mg or equivalent per day5-ASA users; Rectal therapies; Orally administered topically acting steroids (budesonide or beclometasone); Therapies for bile acid diarrhoea (cholestyramine, colesevelam, colestipol); Antidiarrhoeals (e.g., loperamide); Antibiotics for bacterial overgrowth or perianal disease
CCFStay on your medications; Do not skip infusion appointments; Consider rescheduling non urgent endoscopic procedures