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- Review Management of inflammatory bowel disease in the COVID-19 era
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Kyeong Ok Kim
, Byung Ik Jang -
Intestinal Research 2022;20(1):3-10.
DOI: https://doi.org/10.5217/ir.2020.00156
Published online: February 3, 2021
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- Correspondence to Byung Ik Jang, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Yeungnam University College of Medicine, 170 Hyeonchung-ro, Nam-gu, Daegu 42415, Korea. Tel: +82-53-650-4092, Fax: +82-53-621-4487, E-mail: jbi@med.yu.ac.kr
• Received: December 7, 2020 • Revised: December 31, 2020 • Accepted: January 4, 2021
© Copyright 2022. Korean Association for the Study of Intestinal Diseases.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
- During the coronavirus disease 2019 (COVID-19) pandemic, many unpredictable changes have occurred in the medical field. Risk of COVID-19 does not seem to increase in patients with inflammatory bowel disease (IBD) considering based on current reports. Current medications for IBD do not increase this risk; on the contrary, some of these might be used as therapeutics against COVID-19 and are under clinical trial. Unless the patients have confirmed COVID-19 and severe pneumonia or a high oxygen demand, medical treatment should be continued during the pandemic, except for the use of high-dose corticosteroids. Adherence to general recommendations such as social distancing, wearing facial masks, and vaccination, especially for pneumococcal infections and influenza, is also required. Patients with COVID-19 need to be withhold immunomodulators or biologics for at least 2 weeks and treated based on both IBD and COVID-19 severity. Prevention of IBD relapse caused by sudden medication interruption is important because negative outcomes associated with disease flare up, such as corticosteroid use or hospitalization, are much riskier than medications. The outpatient clinic and infusion center for biologics need to be reserved safe spaces, and endoscopy or surgery should be considered in urgent cases only.
INTRODUCTION
RISK OF COVID-19 IN IBD PATIENTS
MEDICATIONS USED FOR IBD, AND RISK OF COVID-19
1) Anti-TNF
2) Vedolizumab and Ustekinumab
GENERAL MANAGEMENT FOR IBD IN COVID-19 PANDEMIC
PRACTICE IN IBD CLINICS
ENDOSCOPY
CLINICAL OUTCOMES AND MANAGEMENT OF IBD PATIENTS WITH CONFIRMED SARS-COV-2 INFECTION
CONCLUSION
-
Funding Source
The authors received no financial support for the research, authorship, and/or publication of this article.
-
Conflict of Interest
No potential conflict of interest relevant to this article was reported.
-
Author Contribution
Conceptualization: Kim KO, Jang BI. Writing the original draft: Kim KO. Writing review and editing: Kim KO, Jang BI. Supervision: Jang BI. Approval of final manuscripts: all authors.
NOTES
Table 1.IBD Medications during COVID-19 Pandemic
| Medication |
IBD in remission |
Active IBD | |||
|---|---|---|---|---|---|
|
No infectiona |
Asymptomatic infection | Symptomatic infection | |||
| New start | Dose escalation | ||||
| 5-ASA | Yes | Yes | Continue | Continue | No medication reduction |
| Budesonide | Yes | Yes | Continue | Continue | Careful consideration about treatment escalation |
| Corticosteroid | No | No | Recommend taper to lower than 20 mg | Recommend taper to lower than 20 mg | |
| Thiopurine/Methotrexate | No | No | Withhold for 2 weeks of symptoms free state | Withhold at least 14 days and 3 days of recoveryb or negative test | |
| Anti-TNF | Yesc | Yes | Withhold for 2 weeks of symptoms free state | Withhold at least 14 days and 3 days of recoveryb or negative test | |
| Vedolizumab | Yes | Yes | Withhold for 2 weeks of symptoms free state | Withhold at least 14 days and 3 days of recoveryb or negative test | |
| Ustekinumab | Yes | Yes | Withhold for 2 weeks of symptoms free state | Withhold at least 14 days and 3 days of recoveryb or negative test | |
| Tofacitinib | No | No | Withhold for 2 weeks of symptoms free state | Withhold at least 14 days and 3 days of recoveryb or negative test | |
a Most experts recommend continuing immunosuppressive treatment if the patients are already on stable maintenance. In patients on combination with anti-TNF and immunomodulators are recommended to stop immunomodulators if they are in remission.
b Defined as no fever and improved respiratory symptoms.
c When considering initiation of anti-TNF during pandemic, monotherapy is recommended.
IBD, inflammatory bowel disease; COVID-19, coronavirus disease 2019; 5-ASA, 5-aminosalicylates; TNF, tumor necrosis factor.
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The Korean Journal of Gastroenterology.2021; 78(2): 105. CrossRef - Risk, Course, and Effect of SARS-CoV-2 Infection in Children and Adults with Chronic Inflammatory Bowel Diseases
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Management of inflammatory bowel disease in the COVID-19 era
Management of inflammatory bowel disease in the COVID-19 era
| Medication | IBD in remission |
Active IBD | |||
|---|---|---|---|---|---|
| No infection |
Asymptomatic infection | Symptomatic infection | |||
| New start | Dose escalation | ||||
| 5-ASA | Yes | Yes | Continue | Continue | No medication reduction |
| Budesonide | Yes | Yes | Continue | Continue | Careful consideration about treatment escalation |
| Corticosteroid | No | No | Recommend taper to lower than 20 mg | Recommend taper to lower than 20 mg | |
| Thiopurine/Methotrexate | No | No | Withhold for 2 weeks of symptoms free state | Withhold at least 14 days and 3 days of recovery |
|
| Anti-TNF | Yes |
Yes | Withhold for 2 weeks of symptoms free state | Withhold at least 14 days and 3 days of recovery |
|
| Vedolizumab | Yes | Yes | Withhold for 2 weeks of symptoms free state | Withhold at least 14 days and 3 days of recovery |
|
| Ustekinumab | Yes | Yes | Withhold for 2 weeks of symptoms free state | Withhold at least 14 days and 3 days of recovery |
|
| Tofacitinib | No | No | Withhold for 2 weeks of symptoms free state | Withhold at least 14 days and 3 days of recovery |
|
Table 1. IBD Medications during COVID-19 Pandemic
Most experts recommend continuing immunosuppressive treatment if the patients are already on stable maintenance. In patients on combination with anti-TNF and immunomodulators are recommended to stop immunomodulators if they are in remission. Defined as no fever and improved respiratory symptoms. When considering initiation of anti-TNF during pandemic, monotherapy is recommended. IBD, inflammatory bowel disease; COVID-19, coronavirus disease 2019; 5-ASA, 5-aminosalicylates; TNF, tumor necrosis factor.
