Guidance for Restarting Inflammatory Bowel Disease Therapy in Patients Who Withheld Immunosuppressant Medications During COVID-19. (21st October 2020)

• Record Type: Journal Article
• Authors: Siegel, Corey A; Christensen, Britt; Kornbluth, Asher; Rosh, Joel R; Kappelman, Michael D; Ungaro, Ryan C; Johnson, Douglas Forsyth; Chapman, Scott; Wohl, David A; Mantzaris, Gerassimos J
• Is Part Of: Journal of Crohn's and colitis. Volume 14(2020)Supplement 3
• Page Start: S769
• Page End: S773
• Publication Date: 2020-10-21
• Subjects: IBD -- Crohn's -- de-escalation -- immunomodulator -- biologic; Inflammatory bowel diseases -- Periodicals; 616.344005
• DOI: 10.1093/ecco-jcc/jjaa135
• Languages: English
• ISSNs: 1873-9946

Abstract

Abstract: Patients with inflammatory bowel diseases [IBD] are frequently treated with immunosuppressant medications. During the coronavirus disease 2019 [COVID-19] pandemic, recommendations for IBD management have included that patients should stay on their immunosuppressant medications if they are not infected with the severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2], but to temporarily hold these medications if symptomatic with COVID-19 or asymptomatic but have tested positive for SARS-CoV-2. As more IBD patients are infected globally, it is important to also understand how to manage IBD medications during convalescence while an individual with IBD is recovering from COVID-19. In this review, we address the differences between a test-based versus a symptoms-based strategy as related to COVID-19, and offer recommendations on when it is appropriate to consider restarting IBD therapy in patients testing positive for SARS-CoV-2 or with clinical symptoms consistent with COVID-19. In general, we recommend a symptoms-based approach, due to the current lack of confidence in the accuracy of available testing and the clinical significance of prolonged detection of virus via molecular testing.