We appreciate the thoughtful comments of Perisetti and colleagues. In line with our article they support our hypothesis that diarrhea in patients with coronavirus disease 2019 (COVID-19) may be related not only to the activity of the new coronavirus but also to the drugs used for its treatment as antibiotics and antivirals. Interestingly, they add that even the cytokine storm generated by COVID-19 may play a role in diarrhea etiopathogenesis by influencing the gut-brain axis and causing increased intestinal permeability.1 If this theory is confirmed, the use of biological drugs such as tumor necrosis factor inhibitors, which selectively block a proinflammatory cytokine and small molecules such as JAK inhibitors, that target entire inflammatory pathways could represent a possible therapeutic option. Two case reports have previously described cases of COVID-19 patients with inflammatory bowel diseases successfully treated with anti–tumor necrosis factor drug2 or JAK inhibitor,3 but the impact of these therapies on diarrhea has not yet been investigated.
Footnotes
Conflicts of interest These authors disclose the following: S. Danese has served as a speaker, consultant, and advisory board member for Schering-Plough, AbbVie, Actelion, Alphawasserman, AstraZeneca, Cellerix, Cosmo Pharmaceuticals, Ferring, Genentech, Grunenthal, Johnson and Johnson, Millenium Takeda, MSD, Nikkiso Europe GmbH, Novo Nordisk, Nycomed, Pfizer, Pharmacosmos, UCB Pharma, and Vifor. L. Peyrin-Biroulet has served as a speaker, consultant, and advisory board member for Merck, AbbVie, Janssen, Genentech, Mitsubishi, Ferring, Norgine, Tillots, Vifor, Hospira/Pfizer, Celltrion, Takeda, Biogaran, Boerhinger-Ingelheim, Lilly, HAC Pharma, Index Pharmaceuticals, Amgen, Sandoz, Forward Pharma GmbH, Celgene, Biogen, Lycera, Samsung Bioepis, and Theravance. The remaining author discloses no conflicts.
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