Table 2. Therapy-specific considerations for pediatric inflammatory bowel disease patients during the COVID-19 pandemic.
| Aminosalicylate acid derivatives (sulfasalazine) |
|
|
| No evidence of increased risk of COVID-19 infection |
| Should never be discontinued |
|
|
| Corticosteroids |
|
|
| Safety during COVID-19 infection is unclear |
| Systemic corticosteroids are not thought to provide clinical benefits |
| Corticosteroids may be used to treat relapse episodes in low doses and for short periods of time. Taper as soon as possible |
|
|
| Immunomodulators (thiopurines and methotrexate) |
|
|
| No evidence of increased risk of COVID-19 infection |
| Immunomodulators have been prescribed in standard doses or intervals to almost all children |
| SARS-CoV-2 Positive and Negative (symptomatic): discontinuation of immunosuppressive therapy is recommended during acute febrile illness and should only be reintroduced when fever subsides, and the child regains normal health(27) |
| Resume treatment two weeks after sign and symptom resolution |
| SARS-CoV-2 Positive (asymptomatic): Therapeutic decisions should be made on an individual basis(26) |
|
|
| Anti-TNF therapy |
|
|
| Only Infliximab and Adalimumab have been approved |
| No evidence of increased risk of COVID-19 infection |
| Maintain dose and infusion intervals |
| SARS-CoV-2 positive and asymptomatic: Biological therapies should be delayed for 2 weeks to monitor for COVID-19 symptoms and resumed after signs and symptoms have subsided(26) |
| Switching from infliximab to adalimumab should be discouraged in stable patients |
Source: adapted from Rubin DT, Feuerstein JD, Wang AY, Cohen RD. AGA clinical practice update on management of inflammatory bowel disease during the COVID-19 Pandemic: expert commentary. Gastroenterology. 2020 Apr 10:S0016-5085(20)30482-0. doi: 10.1053/j.gastro.2020.04.012. [Epub ahead of print];(26) Turner D, Huang Y, Martín-de-Carpi J, Aloi M, Focht G, Kang B, Zhou Y, Sanchez C, Kappelman MD, Uhlig HH, Pujol-Muncunill G, Ledder O, Lionetti P, Dias JA, Ruemmele FM, Russell RK; Paediatric IBD Porto group of ESPGHAN. Corona Virus Disease 2019 and Paediatric Inflammatory Bowel Diseases: Global Experience and Provisional Guidance (March 2020) from the Paediatric IBD Porto Group of European Society of Paediatric Gastroenterology, Hepatology, and Nutrition. J Pediatr Gastroenterol Nutr. 2020;70(6):727-33;(27) Queiroz NS, Barros LL, Azevedo MF, Oba J, Sobrado CW, Carlos AS, et al. Management of inflammatory bowel disease patients in the COVID-19 pandemic era: a Brazilian tertiary referral center guidance. Clinics (São Paulo). 2020;75:e1909.(29)
SARS-CoV-2: severe acute respiratory syndrome coronavirus 2; TNF: tumor necrosis factor.