Table 1.
Summary of New Knowledge and Clinical Implications/Recommendations
| New Knowledge | Clinical Implication/Recommendation |
|---|---|
| Patients with IBD, including those on biological therapy, do not seem to be at increased risk of contracting SARS-CoV-2 compared with the general public | Standard precautions (wear a mask, wash your hands, and social distance) are sufficient for most patients with IBD |
| Age and comorbidities in addition to IBD confer increased risk of severe COVID-19 | As with other non-IBD populations, older age (>65) and the presence of non-IBD comorbidities should be used to risk stratify patients with IBD and inform clinical/treatment decisions as well as lifestyle decisions such as work, school, and the degree of physical distancing (“shielding”). |
| Systemic corticosteroids significantly increase the risk of severe COVID-19 | Corticosteroid use to treat IBD should be minimized to the extent reasonably possible throughout the pandemic. |
| Combination therapy and thiopurine monotherapy are associated with severe COVID-19 compared with anti-TNF monotherapy, especially in older patients. | In selected high-risk patients (older, multiple comorbidities), withdraw of combination therapy in favor of anti-TNF monotherapy should be considered, particularly in patients who have achieved a durable deep remission. |
| Biologics (in particular anti-TNF agents) and small molecules do not appear to be associated an increased risk of severe COVID-19. | Most other IBD therapies do not appear to be associated with substantial COVID-19 safety signals, and hence should be continued during the pandemic. Prior recommendations to temporarily hold biologics and other IBD therapies in the setting of acute COVID-19 infection should be reconsidered, given paucity of data suggesting a harmful effect of such treatments. |
| Mesalamines may be associated with an increased risk of severe COVID-19 | We in general would not avoid use of mesalamines but, until further data are available to confirm or refute this observation, recommend avoiding in situations where their efficacy is limited (Crohn’s disease and after escalating to a biologic in ulcerative colitis). |
COVID-19, coronavirus disease-2019; IBD, inflammatory bowel disease; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2; TNF, tumor necrosis factor.