Table 1.
Final Assessment of Statements Related to Risk of Infection with SARS-CoV-2 or development of COVID-19 in Patients with IBD by the IOIBD Panel (n = 66 participants)
| 76 Statements | Median | SD | Category | DI |
|---|---|---|---|---|
| Risk of infection/disease | ||||
| The risk of infection with SARS-CoV-2 is the same whether a patient has IBD or does not have IBD. | 8 | 1.7 | Appropriate | –0.71 |
| Independent of treatment, patients with Crohn’s disease have a greater risk of infection with SARS-CoV-2 than the general population. | 2 | 1.7 | Inappropriate | 0.16 |
| Independent of treatment, patients with ulcerative colitis have a greater risk of infection with SARS-CoV-2 than the general population. | 2 | 1.7 | Inappropriate | 0.16 |
| Having active inflammation from IBD increases the risk of getting SARS-CoV-2. | 5.5 | 1.8 | Uncertain | 0.63 |
| Patients with IBD who are exposed to SARS-CoV-2 have a higher risk of developing COVID-19 compared to patients without IBD. | 5 | 1.7 | Uncertain | 0.52 |
| Patients with IBD who have COVID-19 have a higher mortality compared to patients without IBD. | 3.5 | 1.7 | Inappropriate | 0.52 |
| Patients with an ostomy are at increased risk for COVID-19. | 2 | 1.2 | Inappropriate | 0.13 |
| Patients with a J pouch are at increased risk for COVID-19. | 2 | 1.2 | Inappropriate | 0.13 |
| Elective surgeries and endoscopies should be postponed at this time. | 8.5 | 1.6 | Appropriate | –0.34 |
| Healthcare workers with IBD on immune modifying medications working in an environment with known or suspected COVID-19 patients should continue working, assuming they are following standard prevention methods. | 5.5 | 2.0 | Uncertain | 2.02 |
| Patients with IBD on immune-modifying medications should discontinue any nonessential travel. | 9 | 1.2 | Appropriate | –0.17 |
| It is safe to continue infusions in an infusion center assuming the infusion center has a screening protocol in place. | 8 | 1.0 | Appropriate | –0.71 |
| Therapy class: 5-ASA | ||||
| 5-ASA increases the risk of infection with SARS-CoV-2. | 1 | 0.7 | Inappropriate | 0.00 |
| 5-ASA increases the risk of COVID-19. | 1 | 0.7 | Inappropriate | 0.12 |
| Patients taking 5-ASA therapy should reduce the dose of therapy to prevent SARS-CoV-2 infection. | 1 | 0.7 | Inappropriate | 0.00 |
| Patients taking 5-ASA therapy should discontinue therapy to prevent SARS-CoV-2 infection. | 1 | 0.7 | Inappropriate | 0.00 |
| Patients taking 5-ASA therapy should stop therapy if they test positive for SARS-CoV-2 but do not have COVID-19. | 1 | 1.1 | Inappropriate | 0.00 |
| Patients taking 5-ASA therapy should stop therapy if they develop COVID-19. | 1 | 1.5 | Inappropriate | 0.13 |
| Therapy class: oral budesonide | ||||
| Budesonide increases the risk of infection with SARS-CoV-2. | 3 | 1.4 | Inappropriate | 0.16 |
| Budesonide increases the risk of COVID-19. | 3 | 1.5 | Inappropriate | 0.22 |
| Patients taking budesonide therapy should reduce the dose of therapy to prevent SARS-CoV-2 infection. | 3 | 1.8 | Inappropriate | 0.16 |
| Patients taking budesonide therapy should discontinue therapy to prevent SARS-CoV-2 infection. | 2 | 1.6 | Inappropriate | 0.16 |
| Patients taking budesonide therapy should stop therapy if they test positive for SARS-CoV-2 but do not have COVID-19. | 4 | 2.1 | Uncertain | 0.52 |
| Patients taking budesonide therapy should stop therapy if they develop COVID-19. | 5 | 2.2 | Uncertain | 0.85 |
| Therapy class: oral prednisone (≥20 mg/d) | ||||
| Prednisone (≥20 mg/d) increases the risk of infection with SARS-CoV-2. | 7 | 2.1 | Appropriate | 2.35 |
| Prednisone (≥20 mg/d) increases the risk of COVID-19. | 7 | 2.0 | Appropriate | 10.00 |
| Patients taking prednisone therapy (≥20 mg/d) should reduce the dose of therapy to prevent SARS-CoV-2 infection. | 7 | 2.0 | Appropriate | 0.00 |
| Patients taking prednisone therapy (≥20 mg/d) should discontinue therapy (taper as appropriate) to prevent SARS-CoV-2 infection. | 7 | 2.3 | Appropriate | 2.35 |
| Patients taking prednisone therapy (≥20 mg/d) should stop therapy (taper as appropriate) if they test positive for SARS-CoV-2 but do not have COVID-19. | 7 | 1.7 | Appropriate | –0.71 |
| Patients taking prednisone therapy (≥20 mg/d) should stop therapy (taper as appropriate) if they develop COVID-19. | 8 | 1.6 | Appropriate | –0.71 |
| Therapy class: thiopurines | ||||
| Azathioprine/6-MP increases the risk of infection with SARS-CoV-2. | 5 | 2.0 | Uncertain | 0.85 |
| Azathioprine/6-MP increases the risk of COVID-19. | 6 | 1.9 | Uncertain | 0.63 |
| Patients taking azathioprine/6-MP should reduce the dose of therapy to prevent SARS-CoV-2 infection. | 3 | 2.1 | Inappropriate | 0.56 |
| Patients taking azathioprine/6-MP should discontinue therapy to prevent SARS-CoV-2 infection. | 3 | 1.9 | Inappropriate | 0.35 |
| Patients taking azathioprine/6-MP should stop therapy if they test positive for SARS-CoV-2 but do not have COVID-19. | 7 | 2.0 | Appropriate | –2.32 |
| Patients taking azathioprine/6-MP should stop therapy if they develop COVID-19. | 8 | 1.5 | Appropriate | –0.71 |
| Therapy: methotrexate | ||||
| Methotrexate increases the risk of infection with SARS-CoV-2. | 4 | 1.7 | Uncertain | 0.52 |
| Methotrexate increases the risk of COVID-19. | 5 | 1.9 | Uncertain | 0.44 |
| Patients taking methotrexate should reduce the dose of therapy to prevent SARS-CoV-2 infection. | 3 | 1.6 | Inappropriate | 0.16 |
| Patients taking methotrexate should discontinue therapy to prevent SARS-CoV-2 infection. | 3 | 1.5 | Inappropriate | 0.16 |
| Patients taking methotrexate should stop therapy if they test positive for SARS-CoV-2 but do not have COVID-19. | 7 | 2.0 | Appropriate | 10.00 |
| Patients taking methotrexate should stop therapy if they develop COVID-19. | 7 | 1.6 | Appropriate | –0.71 |
| Therapy class: anti-TNF | ||||
| Anti-TNF therapy increases the risk of infection with SARS-CoV-2. | 4 | 1.7 | Uncertain | 0.22 |
| Anti-TNF therapy increases the risk of COVID-19. | 4 | 1.7 | Uncertain | 0.52 |
| Patients taking anti-TNF therapy should reduce the dose of therapy to prevent SARS-CoV-2 infection. | 2 | 1.4 | Inappropriate | 0.16 |
| Patients taking anti-TNF therapy should discontinue therapy to prevent SARS-CoV-2 infection. | 2 | 1.2 | Inappropriate | 0.00 |
| Patients taking anti-TNF therapy should stop therapy if they test positive for SARS-CoV-2 but do not have COVID-19. | 6 | 2.2 | Uncertain | 2.35 |
| Patients taking anti-TNF therapy should stop therapy if they develop COVID-19. | 7 | 2.0 | Appropriate | –0.71 |
| Therapy: vedolizumab | ||||
| Vedolizumab increases the risk of infection with SARS-CoV-2. | 3 | 1.5 | Inappropriate | 0.16 |
| Vedolizumab increases the risk of COVID-19. | 3 | 1.6 | Inappropriate | 0.37 |
| Patients taking vedolizumab should reduce the dose of therapy to prevent SARS-CoV-2 infection. | 2 | 1.3 | Inappropriate | 0.15 |
| Patients taking vedolizumab should discontinue therapy to prevent SARS-CoV-2 infection. | 2 | 1.2 | Inappropriate | 0.00 |
| Patients taking vedolizumab should stop therapy if they test positive for SARS-CoV-2 but do not have COVID-19. | 5 | 2.2 | Uncertain | 0.85 |
| Patients taking vedolizumab should stop therapy if they develop COVID-19. | 6 | 2.1 | Uncertain | 2.35 |
| Therapy: ustekinumab | ||||
| Ustekinumab increases the risk of infection with SARS-CoV-2. | 3 | 1.5 | Inappropriate | 0.16 |
| Ustekinumab increases the risk of COVID-19. | 3 | 1.6 | Inappropriate | 0.16 |
| Patients taking ustekinumab should reduce the dose of therapy to prevent SARS-CoV-2 infection. | 2 | 1.1 | Inappropriate | 0.16 |
| Patients taking ustekinumab should discontinue therapy to prevent SARS-CoV-2 infection. | 2 | 1.1 | Inappropriate | 0.00 |
| Patients taking ustekinumab should stop therapy if they test positive for SARS-CoV-2 but do not have COVID-19. | 6 | 2.1 | Uncertain | 2.35 |
| Patients taking ustekinumab should stop therapy if they develop COVID-19. | 7 | 2.1 | Appropriate | –1.57 |
| Therapy: tofacitinib | ||||
| Tofacitinib increases the risk of infection with SARS-CoV-2. | 5 | 1.9 | Uncertain | 0.52 |
| Tofacitinib increases the risk of COVID-19. | 5 | 1.9 | Uncertain | 0.32 |
| Patients taking tofacitinib should reduce the dose of therapy to prevent SARS-CoV-2 infection. | 3 | 1.9 | Inappropriate | 0.19 |
| Patients taking tofacitinib should discontinue therapy to prevent SARS-CoV-2 infection. | 3 | 1.5 | Inappropriate | 0.16 |
| Patients taking tofacitinib should stop therapy if they test positive for SARS-CoV-2 but do not have COVID-19. | 7 | 1.9 | Appropriate | 10.00 |
| Patients taking tofacitinib should stop therapy if they develop COVID-19. | 8 | 1.6 | Appropriate | –0.71 |
| Combination therapy | ||||
| Patients taking combination therapy with an anti-TNF and thiopurine/methotrexate should reduce the dose of the thiopurine/methotrexate to prevent infection from SARS-CoV-2. | 4 | 2.2 | Uncertain | 0.91 |
| Patients taking combination therapy with an anti-TNF and thiopurine/methotrexate should stop the thiopurine/methotrexate if they test positive for SARS-CoV-2 but do not have COVID-19. | 7 | 2.2 | Appropriate | –3.30 |
| Patients taking combination therapy with an anti-TNF and thiopurine/methotrexate should stop the thiopurine/methotrexate if they develop COVID-19. | 8 | 1.3 | Appropriate | 0.00 |
| Clinical trials | ||||
| Patients taking clinical trial drugs should discontinue therapy to prevent SARS-CoV-2 infection. | 2 | 1.4 | Inappropriate | 0.16 |
| Patients taking clinical trial drugs should stop therapy if they test positive for SARS-CoV-2 but do not have COVID-19. | 7 | 1.9 | Appropriate | 10.00 |
| Patients taking clinical trial drugs should stop therapy if they develop COVID-19. | 8 | 1.6 | Appropriate | –0.32 |
| Approach to active disease | ||||
| A patient with moderately to severely active Crohn’s disease or ulcerative colitis (new diagnosis or relapsing disease) should be treated with the same therapies you would choose in the pre-COVID-19 era. | 7 | 2.1 | Appropriate | 10.00 |
| Treatment of IBD after SARS-coV-2 infection or COVID-19 | ||||
| In an IBD patient who tests positive for SARS-CoV-2 and whose IBD meds have been stopped because of this, IBD meds can be restarted after 14 days (provided they have not developed COVID-19). | 7 | 1.5 | Appropriate | –0.71 |
| 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. | 7 | 1.9 | Appropriate | 10.00 |
| 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. | 8 | 1.6 | Appropriate | –0.71 |
5-ASA, 5-aminosalicylic acid; 6-MP, mercaptopurine; COVID-19, coronavirus disease 2019; DI, disagreement index; IBD, inflammatory bowel disease; IOIBD, International Organization for the Study of Inflammatory Bowel Diseases; SARS-CoV-2, severe acute respiratory syndrome-coronavirus-2; SD, standard deviation; TNF, tumor necrosis factor.