New Guidance for Commencing IBD Treatment During the COVID-19 Pandemic

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Patients with IBD should not alter their treatment during the COVID-19 pandemic; however, starting a new treatment regimen should be avoided.

Patients with inflammatory bowel disease (IBD) should not alter treatment during the global pandemic of COVID-19; however, starting a new treatment regimen should be avoided, if possible. If therapy cannot be delayed, thorough testing for viral infection is recommended, according to an article published in Digestive and Liver Disease.

While the most common symptoms of COVID-19 include respiratory distress and pneumonia, some patients experience gastrointestinal symptoms prior to the onset of fever and cough. These gastrointestinal symptoms may alter bowel function and increase the risk for SARS-CoV-2 fecal-oral transmission.

Among patients with COVID-19, those with IBD are of particular concern not only because the impact of the virus on the gastrointestinal tract remains poorly understood, but also because such patients typically receive treatment with immunosuppressive drugs. Article authors recommended that treatment regimens should not be interrupted when possible, and that outpatient clinics should be reorganized to avoid new viral outbreaks.

Study authors recommended that commencing a new immunosuppressive or biologic treatment should be avoided. If delaying treatment is not possible, they suggest that certain protective measures should be taken. At the time of publication, pretreatment screening during the COVID-19 pandemic included tests for hepatitis B and C, HIV, varicella zoster virus, tuberculosis, and herpes simplex virus. Authors also recommended pretreatment immunizations for BCG, diphtheria, tetanus, pertussis, Hemophilus influenzae type B, polio, meningococcus, measles, mumps, rubella, pneumococcus, human papillomavirus, rotavirus, influenza, and varicella zoster virus. The article authors recommended an additional pretreatment screening for active SARS-CoV-2 in all patients using RT-PCR and assessment of previous infection through serum IgM/IgG immunoassay.

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These recommendations were made due to the uncertainties of how patients using immunosuppressive or immunomodulator therapies differed in their COVID-19 disease course. Patients with IBD may have delayed viral clearance, higher viral load, prolonged viral shedding, and/or impaired antibody response.

The article authors concluded that a pragmatic approach should be undertaken when starting a new treatment regimen in patients with IBD until it becomes clear how typical IBD treatments impact long-term outcomes of a COVID-19 infection.

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Zingone F, Buda A, Savarino E V. Screening for active COVID-19 infection and immunization status prior to biologic therapy in IBD patients at the time of the pandemic outbreak. [available online April 10, 2020]. Dig Liver Dis. doi:10.1016/j.dld.2020.04.004