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Institute of IBD (IOIBD) Recommendations: SonarMD’s Chief Medical Officer highlights key take-aways for people with Crohn’s Disease and Ulcerative Colitis

These statements represent the summation of expert opinion and should be interpreted in the context of the individual patient and the managing healthcare provider who knows her or him. These are not guidelines, and these may be updated as knowledge and the situation evolve. To date, there are limited data about patients with IBD who have COVID-19.

Risk of Infection: Do's and Don'ts

  1. The risk of infection with SARS-CoV-2 is the same whether a patient has IBD, or does not have IBD.
  2. Independent of treatment, patients with Crohn’s disease do not have a greater risk of infection with SARS-CoV-2 than the general population.
  3. Independent of treatment, patients with ulcerative colitis do not have a greater risk of infection with SARS-CoV-2 than the general population.
  4. Patients with an ostomy or a J Pouch are not at increased risk for COVID-19.
  5. Elective surgeries and endoscopies should be postponed at this time.
  6. Patients with IBD on immune-modifying medications should discontinue any non-essential travel.
  7. It is safe to continue infusions in an infusion center, assuming the infusion center has a screening protocol in place.

Medication and Therapies

  1. They do not increase the risk of COVID-19
  2. You should not reduce or discontinue the dose of your therapy to prevent SARS-CoV-2 infection
  3. You should not stop therapy if they test positive for COVID-19
  1. Budesonide does not increase the risk of infection with COVID-19
  2. You should not reduce the dose of therapy to prevent COVID-19 infection
  3. It is uncertain if patients taking budesonide therapy should stop therapy if they develop COVID-19
  1. Prednisone (≥20mg/d) increases the risk of infection with COVID-19
  2. Patients taking prednisone therapy (≥20mg/d) should reduce the dose of therapy to prevent SARS-CoV-2 infection. Discuss this with your physician
  3. Patients taking prednisone therapy (≥20mg/d) should stop therapy (taper as appropriate) if they test positive for COVID-19. – discuss with your physician
  1. It is uncertain if azathioprine/6-MP increases the risk of infection with COVID-19
  2. Patients taking azathioprine/6-MP should not reduce the dose of therapy to prevent COVID-19 infection
  3. Patients taking azathioprine/6-MP should stop therapy if they test positive for COVID-19
    1. It is uncertain if methotrexate increases the risk of infection with COVID-19
    2. Patients taking methotrexate should not reduce the dose of therapy to prevent COVID-19 infection
    3. Patients taking methotrexate should stop therapy if they test positive for COVID-19
  1. It is uncertain if anti-TNF therapy increases the risk of infection with COVID-19
  2. Patients taking anti-TNF therapy should not reduce the dose of therapy to prevent COVID-19
  3. Patients taking anti-TNF therapy should stop therapy if they develop COVID-19
  1. Vedolizumab does not increase the risk of infection with COVID-19
  2. Patients taking vedolizumab should not reduce the dose of therapy to prevent COVID-19 infection
  3. It is uncertain if patients taking vedolizumab should stop therapy if they test positive for COVID-19
  1. It is uncertain if tofacitinib increases the risk of infection with COVID-19
  2. Patients taking tofacitinib should not reduce the dose of therapy to prevent COVID-19
  3. Patients taking tofacitinib should stop therapy if they develop COVID-19
  1. It is uncertain if patients taking combination therapy with an anti-TNF and thiopurine/methotrexate should reduce the dose of the thiopurine/methotrexate to prevent infection from COVID-19
  2. Patients taking combination therapy with an anti-TNF and thiopurine/methotrexate should stop the thiopurine/methotrexate if they test positive for COVID-19

A patient with moderately to severely active Crohn’s disease or ulcerative colitis should be treated with the same therapies they would choose in the pre-COVID-19 era

  1. In an IBD patient who tests positive for SARS-CoV-2 and whose IBD medications have been stopped because of this, IBD meds can be restarted after 14 days (provided they have not developed COVID-19)
  2. In an IBD patient who develops COVID-19 and whose IBD meds have been stopped, IBD meds can be restarted after COVID-19 symptoms resolve
  3. In an IBD patient who develops COVID-19 and whose IBD meds have been stopped, IBD meds can be restarted after 2 nasopharyngeal PCR tests are negative

*? indicates “uncertain at this time”

Clinical Trials

  1. Patients taking clinical trial drugs should not stop therapy to prevent SARS-CoV-2 infection.
  2. Patients taking clinical trial drugs should stop therapy if they test positive for SARS-CoV-2 but don’t have COVID-19.
  3. Patients taking clinical trial drugs should stop therapy if they develop COVID-19.

To access the full IOIBD Update on COVID-19 for Patients with Crohn’s Disease and Ulcerative Colitis, visit: https://www.ioibd.org/ioibd-update-on-covid19-for-patients-with-crohns-disease-and-ulcerative-colitis/

Additional information can be found here:

  1. International registry for IBD patients with COVID-19: www.covidibd.org
  2. Crohn’s & Colitis Foundation: www.crohnscolitisfoundation.org/coronavirus
  3. World Health Organization: www.WHO.int
  4. Centers for Disease Control and Prevention: www.CDC.gov

 

As always, if you have specific questions related to your individual condition or treatment, we recommend you consult with your gastroenterologist.

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