Guidance for Restarting Inflammatory Bowel Disease Therapy in Patients Who Withheld Immunosuppressant Medications During COVID-19

• Published in: Journal of Crohn's and Colitis 2020-10, Vol.14 (Supplement_3), p.S769-S773
• Main 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
• Format: Article
• Language: English
• Subjects: Asymptomatic Infections; Betacoronavirus - isolation & purification; Clinical Laboratory Techniques; Coronavirus Infections - diagnosis; Coronavirus Infections - immunology; Coronavirus Infections - prevention & control; COVID-19; COVID-19 Testing; Drug Administration Schedule; Humans; Immunocompromised Host; Immunosuppressive Agents - administration & dosage; Immunosuppressive Agents - therapeutic use; Inflammatory Bowel Diseases - complications; Inflammatory Bowel Diseases - drug therapy; Inflammatory Bowel Diseases - immunology; Pandemics - prevention & control; Pneumonia, Viral - diagnosis; Pneumonia, Viral - immunology; Pneumonia, Viral - prevention & control; Risk Assessment; SARS-CoV-2; Supplement
• ISSN: 1873-9946; 1876-4479
• DOI: 10.1093/ecco-jcc/jjaa135

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.