Table 1.
IBD Medications during COVID-19 Pandemic
| Medication | IBD in remission |
Active IBD | |||
|---|---|---|---|---|---|
| No infectiona |
Asymptomatic infection | Symptomatic infection | |||
| New start | Dose escalation | ||||
| 5-ASA | Yes | Yes | Continue | Continue | No medication reduction |
| Budesonide | Yes | Yes | Continue | Continue | Careful consideration about treatment escalation |
| Corticosteroid | No | No | Recommend taper to lower than 20 mg | Recommend taper to lower than 20 mg | |
| Thiopurine/Methotrexate | No | No | Withhold for 2 weeks of symptoms free state | Withhold at least 14 days and 3 days of recoveryb or negative test | |
| Anti-TNF | Yesc | Yes | Withhold for 2 weeks of symptoms free state | Withhold at least 14 days and 3 days of recoveryb or negative test | |
| Vedolizumab | Yes | Yes | Withhold for 2 weeks of symptoms free state | Withhold at least 14 days and 3 days of recoveryb or negative test | |
| Ustekinumab | Yes | Yes | Withhold for 2 weeks of symptoms free state | Withhold at least 14 days and 3 days of recoveryb or negative test | |
| Tofacitinib | No | No | Withhold for 2 weeks of symptoms free state | Withhold at least 14 days and 3 days of recoveryb or negative test | |
a
Most experts recommend continuing immunosuppressive treatment if the patients are already on stable maintenance. In patients on combination with anti-TNF and immunomodulators are recommended to stop immunomodulators if they are in remission.
b
Defined as no fever and improved respiratory symptoms.
c
When considering initiation of anti-TNF during pandemic, monotherapy is recommended.
IBD, inflammatory bowel disease; COVID-19, coronavirus disease 2019; 5-ASA, 5-aminosalicylates; TNF, tumor necrosis factor.