AGA issues new guidance for IBD management during COVID-19 pandemic
The American Gastroenterological Association issued new guidance for the clinical management of patients with inflammatory bowel disease during the COVID-19 pandemic.
“While the COVID-19 pandemic is a global health emergency, patients with IBD have particular concerns for their risk for infection and management of their medical therapies,” the AGA said in a release. “This clinical practice update incorporates the emerging understanding of COVID-19 and summarizes available guidance for patients with IBD and the providers who take care of them.”
In the expert commentary, David T. Rubin, MD, of the University of Chicago Inflammatory Bowel Disease Center, and colleagues sought to answer some questions and offer clear guidance on what steps to take if and when a patient with IBD develops COVID-19.
Are patients with IBD at increased risk for infection with SARS-CoV-2 or development of COVID-19?
There had been some concern that patients with IBD were at higher risk because they are regularly on immunosuppressive therapies and their need to be at medical facilities for treatment might increase exposure risk. However, Rubin and colleagues said this does not appear to be the case.
“Despite the potential for increased exposure to SARS-CoV-2, the limited available data and expert opinion suggest that patients with IBD do not appear to have a baseline increased risk of infection with SARS-CoV-2 or development of COVID-19,” they wrote. “It is unclear whether inflammation of the bowel per se is a risk for infection with SARS-CoV-2, but it is sensible that patients with IBD should maintain remission in order to reduce the risk of relapse and need for more intense medical therapy or hospitalization.”
What are the outcomes if a patient with IBD develops COVID-19?
As with many aspects of COVID-19, the data needed to answer this question are limited.
“It is too early to make definitive conclusions, but of 164 patients reported to the registry at the time of this writing, patients with severe IBD and COVID-19 (reported as Physician’s Global Assessment) are more likely to be hospitalized related to their IBD or COVID-19 (or both),” Rubin and colleagues wrote. “We anticipate more robust data in the upcoming one to two months as the cases worldwide grow.”
The SECURE-IBD international registry was established to collect more information on how IBD and COVID-19 might interact. Part of the AGA guidance is to ask physicians to submit cases of IBD and confirmed COVID-19 to the registry.
What to do with therapy?
Possibly the biggest question that has lingered over the management of IBD during the pandemic is what to do with therapy. Rubin and colleagues broke down the guidance based on whether or not the patient tested positive for SARS-CoV-2 and if they are exhibiting symptoms.
For patients with IBD who are not infected with the virus, they wrote that the goal should be maintaining remission, and therefore, patients should stay on their therapies.
“Aside from the obvious negative consequences of a relapse, relapsing IBD will strain available medical resources, may require steroid therapy or necessitate hospitalization, outcomes that are all much worse than the known risks of existing IBD therapies,” they wrote. “Similar to the recommendations to the general population, patients with IBD should practice strict social distancing, work from home, have meticulous hand hygiene, and separate themselves from known infected individuals.”
If a patient with IBD tests positive for SARS-CoV-2, thiopurines, methotrexate and tofacitinib should be temporarily held, Rubin and colleagues wrote. Biologic therapies should also be held. If symptoms of COVID-19 have not yet manifested, biologic dosing can be delayed for 2 weeks while monitoring for symptoms. – by Alex Young
Disclosure: Rubin reports receiving grant support from Takeda and serving as a consultant for AbbVie, Abgenomics, Allergan Inc., Boehringer Ingelheim Ltd., Bristol-Myers Squibb, Celgene Corp/Syneos, Dizal Pharmaceuticals, Eli Lilly, GalenPharma/Atlantica, Genentech/Roche, Gilead Sciences, Ichnos Sciences S.A., GlaxoSmithKline Services, Janssen Pharmaceuticals, Pfizer, Prometheus Laboratories, Reistone, Shire, Takeda, and Techlab Inc. Please see the full study for all other authors’ relevant financial disclosures.