Reply

Reply. We thank Chen and colleagues for their letter¹ that shows the association between therapy discontinuation and worsening of symptoms and outcomes (eg, hospitalization, surgery, and intestinal complications) in patients with inflammatory bowel disease (IBD) during the coronavirus disease 2019 (COVID-19) pandemic. In their cohort, 13% of patients had spontaneously discontinued the IBD therapy due to concerns about COVID-19 infection or adverse drug reactions, leading to disease worsening in approximately a quarter of cases. However, it is not known whether these patients received recommendations regarding therapy from health care professionals. Interestingly, in a recent global survey including nearly 4000 patients with IBD, most of the participants were afraid of contracting severe acute respiratory syndrome coronavirus 2 infection and attending the hospital for scheduled follow-up.² In addition, approximately two-thirds of respondents believed that immunosuppressive drugs were associated with an increased risk of developing COVID-19. Of note, a 4% voluntary drug discontinuation rate was found, and most patients did not want to discontinue current medications. It is important to highlight that approximately half of the subjects did not receive medical recommendations to prevent the viral infection. Furthermore, among patients who received recommendations, many requested additional clarification, emphasizing the lack of adequate communication between physicians and patients. Proper patient education is essential to minimize patient concerns and ensure a higher rate of treatment adherence. Telemedicine is a valid option to fill the existing gap, but further efforts are needed to improve its acceptance by patients and increase its use in the daily clinical routine.³ Moreover, patient associations should be more involved to facilitate the dissemination of appropriate information, to improve adherence to treatments, and to ensure the optimal management of patients with IBD.