TABLE 2.
Questions 4–6
| Country | If an IBD patient develops COVID-19, how does this affect other treatment? | What is the role of surgery in IBD in the face of COVID-19? Does COVID-19 affect the indications for surgery or the scope of surgical interventions? | If, in a low resource area and there is no access to biologicals, how does one address steroid use in the current environment of COVID-19 concern? |
|---|---|---|---|
| Bangladesh (n = 2) | No cases yet (n = 2) | Limited surgery availability (n = 1) Urgent surgeries only (n = 1) | Avoid steroids or use lowest possible dose (n = 1) No change in steroid dosing unless COVID-19 positive (n = 1) |
| Brazil (n = 4) | D/C immunomodulatory therapy | Urgent surgeries only | Avoid steroids (n = 1) Selective use (n = 2) Only use budesonide (n = 1) |
| Canada (n = 3) | D/C immunomodulatory therapy Rapid steroid taper | Urgent surgeries only | Selective use (n = 3) Use budesonide (n = 2) |
| China (n = 4) | Reduce or discontinue immunomodulatory therapy D/C steroids (n = 2) | Urgent surgeries only Pre-op testing for COVID-19 (n = 1) | Avoid steroids (n = 3). Use budesonide (n = 1) |
| France (n = 1) | D/C immunomodulatory therapy D/C steroids | Urgent surgeries only | Avoid steroids. Good access to biological therapy |
| Hong Kong (n = 1) | D/C immunomodulatory therapy D/C steroids | Urgent surgeries only | Avoid steroid use; use budesonide |
| India (n = 2) | D/C immunomodulatory therapy (n = 1) May continue therapy depending on severity of and IBD (n = 1) | Urgent surgeries only Laparoscopy after COVID testing (n = 1) | Steroids use more selective, taper more rapid |
| Indonesia (n = 1) | D/C immunomodulatory therapy | No change in approach to surgery | Avoid steroid use |
| Israel (n = 2) | D/C immunomodulatory therapy | Urgent surgeries only (n = 1) No change in surgeries (n = 1, pediatric) | Steroids as needed |
| Kenya (n = 2) | Impact on steroid use (No = 1) No change (n = 1) | No change in approach to surgery (n = 1) Urgent surgeries only (n = 1) | Use more thiopurines and if using steroids patient is in isolation (n = 1) Taper rapidly, reduce dose (n = 1) |
| Korea (n = 1) | D/C immunomodulatory therapy D/C steroids | Urgent surgeries only | Avoid steroid use, rapid tapering Use budesonide |
| Kuwait (n = 1) | Switch IV biological therapy to SC Avoid steroids | ? | Avoid steroids |
| Malaysia (n = 2) | Continue maintenance therapy (n = 1) D/C immunomodulatory therapy (n = 1) | Urgent surgeries only | Rapid steroid taper |
| Mexico (n = 1) | 5ASA, budesonide, vedolizumab continued; D/C other immunomodulatory therapy D/C steroids | Urgent surgeries only | Selective steroid use where biological therapy can not be accessed budesonide used. |
| Myanmar (n = 2) | D/C immunomodulatory therapy | Urgent surgeries only. Done in negative pressure operating room. | Avoid steroids; use budesonide |
| Nepal (n = 1) | Use lower dose steroids | Urgent surgeries only | Avoid steroid use, rapid tapering |
| New Zealand (n = 1) | D/C immunomodulatory therapy | Urgent surgeries only | Avoid steroid use |
| Pakistan (n = 2) | Continue 5ASA, thiopurines, reduce steroids, biological therapy not available (n = 1) No cases yet (n = 1) | Urgent surgeries only Pre-op testing for COVID-19 (n = 1) | No change in steroid use (n = 1) Use as little as possible (n = 1) |
| Philippines (n = 1) | No change in mild cases | Avoiding surgery as much as possible | Shorten period of steroid use |
| Portugal (n = 2) | D/C immunomodulatory therapy Rapid steroid taper | Urgent surgeries only | Use steroids if needed even if Covid-19 positive (n = 1) Using steroids to induce remission if starting biologicals but otherwise avoiding doses above 10 mg (n = 1) |
| Puerto Rico (n = 1) | No cases yet | Urgent surgeries only | Avoid steroids; good access to biologicals |
| Qatar (n = 1) | Only biological therapy discontinued | Urgent surgeries only | If steroids required patient would be in isolation |
| Romania (n = 1) | No cases yet | Urgent surgeries only | Avoid steroids; good access to biologicals |
| Saudi Arabia (n = 1) | Continue 5ASA, thiopurines; Continue biological therapy depending on disease severity D/C steroids | Urgent surgeries only | Avoid steroids |
| Singapore (n = 1) | No cases yet | Urgent surgeries only | Avoid steroids; good access to biologicals |
| South Africa (n = 1) | No cases yet | Surgeries on hold (no mention of urgent cases) | Avoid steroid use except in acute severe colitis |
| Sri Lanka (n = 1) | No cases yet | Urgent surgeries only (i.e. obstruction or abscess in Crohn’s disease) | Lower doses and short courses when needed |
| Taiwan (n = 1) | Continue immunomodulatory therapy D/C steroids | No change | Avoid steroids; good access to biologicals |
| Thailand (n = 3) | D/C immunomodulatory therapy D/C steroids | Urgent surgeries only (n = 2) Avoid surgery when possible (n = 1) | Use steroids with taper |
| Uruguay (n = 1) | No cases yet | Urgent surgeries only | ? |
| United Kingdom (n = 1) | D/C immunomodulatory therapy | Urgent surgeries only Laparoscopy after COVID testing | Rapid steroid taper |
| United States (n = 2) | D/C thiopurine and anti TNF; Continue Vedolizumab and Ustekinumab (n = 1) D/C immunomodulatory therapy D/C steroids (n = 1) | Urgent surgeries only | Use steroids if necessary after 7 days of infection onset (n = 1) Avoid steroids (n = 1) |
| Vietnam (n = 1) | No cases yet | Urgent surgeries only Pre-op testing for COVID-19 (n = 1) | No change in steroid use; confirm COVID-19 negative |
Abbreviations: n refers to number of respondents from that country. “?” refers to unclear response on that question. D/C, discontinue.