AGA Releases Expert Commentary for IBD Management During COVID-19

The American Gastroenterological Association (AGA) published their expert commentary update on the management of inflammatory bowel disease (IBD) during the current pandemic.¹

AGA’s recommendations, which were published in Gastroenterology, stress that individuals with IBD may have heightened concerns not only for their particular risk of infection, but also in managing their medication therapies in the face of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes the novel coronavirus 2019 (COVID-19).¹

The expert commentary suggests that patients who have necessary visits to medical facilities for infusions or endoscopic procedures have the potential for increased exposure.²

Although data concerning the effect of COVID-19 on IBD remain limited in availability and scope, the experts from AGA noted several studies in their commentary.²

One study from Wuhan, China, reported that patient-defined diarrhea was present in only 10.1% of hospitalized patients with COVID-19. Another study demonstrated that while approximately half of patients with COVID-19 had digestive symptoms, only one-third experienced diarrhea.²

Hence, current available data and expert opinion suggested that patients with IBD “do not appear to have a baseline increased risk of infection with SARS-CoV-2 or development of COVID-19.”²

As such, the recommendations suggest that patients with IBD without COVID-19 symptoms should continue their current regimens and therapies, including upcoming infusions, rather than resorting to relapse. The consequences of relapse, aside from the obvious negative effects, include strained available IBD medical resources and potential steroid therapy and even hospitalization. Patients with IBD without COVID-19 symptoms should follow CDC’s current guidelines, including strict social distancing, working from home, practicing quality hand hygiene, and keep clear of known infected individuals.²

However, the protocol changes if an individual with IBD has expressed symptoms of SARS-CoV-2. The commentary offered these recommendations in this case:¹

1) Stop thiopurines, methotrexate, tofacitinib
2) Stop biological therapies (including anti-TNF, ustekinumab, vedolizumab)
3) Restart therapies after confirmed resolution of COVID-19 symptoms – patients should make sure to speak with a health care expert before pausing medication use

The commentary’s authors offered timely recommendations to patients with IBD using developing data and expert opinion. “In all of these reports, patients with digestive symptoms most frequently had concurrent fever and respiratory symptoms as well. Given the prevalence of non-specific digestive symptoms in the population and especially in patients with IBD, the clinical implications of this are quite important,” they asserted.

“Patients who develop new digestive symptoms but who do not have fever or respiratory symptoms can be monitored for the progression of symptoms that might guide timing of testing for SARS-CoV-2, and in patients with IBD, trigger additional treatment adjustments.”

Physicians are being asked to report their IBD COVID-19 cases to COVIDIBD.org.¹

The AGA Clinical Practice Update on Management of Inflammatory Bowel Disease During the COVID-19 Pandemic: Expert Commentary is available here.²

References:

1. AGA releases official guidance for patients with IBD during the COVID-19 pandemic. News Release. EurekAlert; April 10, 2020. Accessed April 21, 2020. https://www.eurekalert.org/pub_releases/2020-04/aga-aro041020.php

2. Rubin DT, Feuerstein JD, Wang AY, et al. AGA Clinical Practice Update on Management of Inflammatory Bowel Disease During the COVID-19 Pandemic: Expert Commentary. Gastroenterology. 2020; doi: https://doi.org/10.1053/j.gastro.2020.04.012