When considering treatments for COVID-19 and whether to increase IBD treatment, clinicians and patients should weigh the risks against the benefits.
Social Distancing Works for Patients With IBD
Evidence from the Wuhan IBD center in China suggests that strict social distancing for patients with IBD works, Rubin said.
Gastroenterologists at Wuhan University instituted a number of measures to protect patients with IBD from COVID-19 nearly 3 weeks before the general shutdown in Wuhan. These included distributing educational information and instructions to patients, updating them as needed, and recording patient information, such as infection risks and actions taken. None of the 318 patients with IBD had been diagnosed with the infection at the end of February.
Individuals with IBD should observe strict social distancing, work from their home, practice careful hand hygiene, and stay away from individuals known to be infected, Rubin and colleagues recommend.
Patients With IBD Who Experience Relapse Need Careful Evaluation
Rubin urges clinicians to “carefully evaluate their IBD patients who have a relapse both because it may be digestive symptoms from COVID-19 instead, but also because much more likely it will be the usual causes — other infections, loss of response to therapy or due to patients who stopped their therapy on their own. A thoughtful clinical approach to these patients is critically important so that our patients can be kept safe and get the treatments that they need.”
He added, “We are learning more every day about COVID-19 and about new options for testing, screening, and outcomes of our IBD patients who get infected. Patients should check with their doctors if they have concerns or questions, and both patients and clinicians should stay tuned as more information becomes available. The IBD community of experts and care providers are all working together.”
A decision support tool and quick reference chart for social sharing are available for download on the AGA website, and clinicians are asked to submit cases involving patients who have both IBD and confirmed COVID-19 to the SECURE-IBD registry.
The AGA Institute Clinical Practice Updates Committee and the AGA Governing Board commissioned and approved this expert commentary. Rubin and Cohen report a variety of financial relationships with pharmaceutical companies and organizations, including AbbVie, Abgenomics, Allergan Inc, BMS/Celgene, Boehringer Ingelheim Ltd, Bristol-Myers Squibb, Celgene Corp-Syneos, Dizal Pharmaceuticals, Eli Lilly, GalenPharma/Atlantica, Genentech/Roche, Gilead Sciences, Hollister, Ichnos Sciences SA, GlaxoSmithKline Services, Janssen Pharmaceuticals, Medimmune, Mesoblast Ltd, Osiris Therapeutics, Pfizer, Prometheus Laboratories, Receptos, RedHill Biopharma, Reistone, Sanofi-Aventis, Schwaz Pharma, Seres Therapeutics, Shire, Takeda, Techlab Inc, UCB Pharma, and the Crohn’s & Colitis Foundation. Cohen’s spouse is on the board of directors at Aerpio Therapeutics, Novus Therapeutics, and NantKwest. The remaining authors have disclosed no relevant financial relationships.