Patients with inflammatory bowel diseases (IBD) with COVID-19 should delay biological therapies, restarting them once symptoms are gone, says a clinical practice update from the American Gastroenterological Association (AGA).
The practice update, written by David T Rubin et al, says that patients with IBD who test positive for SARS-CoV-2 but have not developed COVID-19 symptoms should hold off on thiopurines, methotrexate, and tofacitinib as well as biological therapies, for 2 weeks while monitoring symptoms. The update is online in the journal Gastroenterology.
The update discusses questions such as:
- Are Patients with IBD at Increased Risk for Infection with SARS-CoV-2 or Development of COVID-19?
- Does Inflammation of the Bowel Affect the Course of COVID-19?
- What Are the Outcomes If a Patient with IBD Develops COVID-19?
- Do IBD Therapies Affect Risk of Infection with SARS-CoV-2?
Take-home points are:
- Patients with IBD do not appear to be at increased risk for infection with SARS-CoV-2 or development of COVID-19.
- Patients with IBD who do not have infection with SARS-CoV-2 should NOT discontinue their IBD therapies and should continue infusion schedules at appropriate infusion centers.
- Patients with IBD who are infected with SARS-CoV-2 but have not developed COVID-19 should hold off on thiopurines, methotrexate, and tofacitinib. Dosing of biological therapies should be delayed for 2 weeks while monitoring for symptoms of COVID-19.
- Patients with IBD who develop COVID-19 should hold off on thiopurines, methotrexate, tofacitinib, and biological therapies during their illness. These may be restarted after complete symptom resolution or a negative result from a virus test.
- The severity of the COVID-19 and the severity of the IBD should be considered in risk to benefit assessment for treatment for of COVID-19 and escalating treatments for IBD.
- Cases of IBD and confirmed COVID-19 should be submitted to the SECURE-IBD registry at COVIDIBD.org.