Review of inflammatory bowel disease and COVID-19

Table 1 Summary of expert opinions and guidelines

Organization	IBD treatment, stable disease (No known or suspected COVID-19)		Known or suspected COVID-19
Chinese IBD Society	May 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 endoscopy		Contact 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)
IOIBD	Continue 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 procedures	Uncertain 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
AGA	Continue current IBD therapies; Continue infusions at appropriate infusion centers; Only perform urgent or emergent procedures	Hold thiopurines, methotrexate, and tofacitinib; Delay biologic therapy for 2 wk while monitoring for COVID-19 symptoms	Hold 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

IBD: Inflammatory bowel disease; COVID-19: Coronavirus disease 2019; TNF: Tumor necrosis factor; SARS-CoV-2: Severe acute respiratory syndrome coronavirus 2; IOIBD: International Organization for the Study of Inflammatory Bowel Disease; DC: Discontinue; IMM: Immunomodulators; AGA: American Gastroenterological Association.

Table 2 Continued summary of expert opinions and guidelines

	General recommendations	Serious COVID-19 disease risk: Highest risk	Moderate risk	Lowest risk
BSG	Continue 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/C	IBD 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 nutrition	Anti-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 day	5-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
CCF	Stay on your medications; Do not skip infusion appointments; Consider rescheduling non urgent endoscopic procedures

COVID-19: Coronavirus disease 2019; BSG: British society of gastroenterology; IBD: Inflammatory bowel disease; TNF: Tumor Necrosis Factor; IMM: Immunomodulators; ASA: Aminosalicylic acids; CCF: Crohn’s and colitis foundation.