key: cord-263419-qeo6qn0d
authors: Fiorino, Gionata; Peyrin-Biroulet, Laurent; Danese, Silvio
title: Protecting patients with IBD during the COVID-19 pandemic
date: 2020-05-20
journal: Lancet Gastroenterol Hepatol
DOI: 10.1016/s2468-1253(20)30152-7
sha: 
doc_id: 263419
cord_uid: qeo6qn0d

nan

IBDs are immune-mediated diseases, which usually require treatment with corticosteroids, immunomodulators, or monoclonal antibodies to induce and maintain clinical and endoscopic remission. The use of these agents can increase the risk of opportunistic infections, but not that of serious infections. Therefore, adoption of adequate measures to prevent and protect patients is an essential part of the quality standards of care in IBD.

An and colleagues stopped biologics (infliximab infusions) and immunosuppressive treatments for all patients with IBD. This decision is challenging. Indeed, a systematic review 4 showed that the risk of hospital admission (odds ratio 0·48, 95% CI 0·29-0·80) and surgery (0·67, 0·46-0·97) is significantly reduced by use of biologics for patients with IBD. The probability of relapse after stopping effective immunomodulators or biological therapy is about 50% and is associated with an increased need for steroids, and risk of hospital admission and surgery. 5 Some considerations are needed. First, SARS-CoV-2 infection should be considered as a serious rather than an opportunistic infection, as the risk of infection is not related to concomitant immunosuppression. Second, severe COVID-19 might be associated with cytokine storm and is possibly related to a hyper-immune response in addition to virus-related damage. Third, around 5% of patients who relapse because of withdrawal of effective therapies will require hospital admission against a backdrop of overwhelmed hospital capacity. Thus, the risk and benefits of continuing or stopping biologics should be carefully balanced and should not be assumed to be a general rule for all patients with IBD, especially given the length of time the pandemic is likely to last.

In conclusion, protection of patients with IBD from COVID-19 is crucial and strongly advisable. Whether stopping or adapting therapies will have substantial positive benefits for patients with IBD requires further, longer-term data from different countries.

Vandoeuvreles

Prevention of COVID-19 in patients with inflammatory bowel disease in Wuhan, China

Inflammatory bowel disease care in the COVID-19 pandemic era: the Humanitas, Milan experience

Management of IBD during the COVID-19 outbreak: resetting clinical priorities

Systematic review with meta-analysis: comparative efficacy of immunosuppressants and biologics for reducing hospitalisation and surgery in Crohn's disease and ulcerative colitis

Systematic review of effects of withdrawal of immunomodulators or biologic agents from patients with inflammatory bowel disease