key: cord-311804-39mu0tdr authors: Zingone, Fabiana; Buda, Andrea; Savarino, Edoardo Vincenzo title: Screening for Active COVID-19 Infection and Immunization Status Prior to Biologic Therapy in IBD Patients at the Time of the Pandemic Outbreak date: 2020-04-10 journal: Dig Liver Dis DOI: 10.1016/j.dld.2020.04.004 sha: doc_id: 311804 cord_uid: 39mu0tdr Coronavirus disease 2019 has been recently classified as pandemic infection by the World Health Organization. Patients with inflammatory bowel disease (IBD) are invited to follow the national recommendations as any other person. It is unclear whether a more aggressive clinical course might develop in asymptomatic COVID-19 infected subjects during biological therapy and current evidence does not support treatment suspension. However, during pandemic, the start of treatment with immunosuppressive drugs and biologics should be postponed whenever possible and based on an individual risk assessment. When clinical conditions and the disease activity do not allow a treatment delay, before starting a biological therapy, screening of IBD patients for COVID-19 active infection by RT-PCR should be advisable, even in absence of clinical suspicion. Serum antibody testing, when available, could provide evidence of infection as well as identify patients already immune to the disease. Organization. Patients with inflammatory bowel disease (IBD) are invited to follow the national recommendations as any other person. It is unclear whether a more aggressive clinical course might develop in asymptomatic COVID-19 infected subjects during biological therapy and current evidence does not support treatment suspension. However, during pandemic, the start of treatment with immunosuppressive drugs and biologics should be postponed whenever possible and based on an individual risk assessment. When clinical conditions and the disease activity do not allow a treatment delay, before starting a biological therapy, screening of IBD patients for COVID-19 active infection by RT-PCR should be advisable, even in absence of clinical suspicion. Serum antibody testing, when available, could provide evidence of infection as well as identify patients already immune to the disease. Coronavirus disease 2019 has been recently classified as a pandemic infection by the World Health Organization and it can present with different clinical manifestations: as an asymptomatic carrier state, acute respiratory disease, and pneumonia. Adults represent the population with the highest infection rate, with severe clinical courses and deaths being more likely in older patients with underlying comorbidities compared to mild cases (1) . Also, male gender seems to be at higher risk of morbidity and mortality. Due to the rapid spread of the disease, governments and the medical community are taking measures to prevent transmission, from common sense recommendations to radical quarantine measures (2) . Accumulating evidence shows that patients with COVID-19 infection may also experience gastrointestinal symptoms, including diarrhea, nausea, vomiting and abdominal discomfort prior to the common respiratory symptoms Current recommendation suggests postponing the start of treatment with immunosuppressive drugs and biologics, whenever possible, based on an individual risk assessment during the COVID19 pandemic (5-7). However, since postponing the drug start is not always possible depending on the clinical activity of the patients, particular measures should be considered in order to reduce COVID-19-related risks. A viral screen is commonly suggested before starting biologics (8) due to the higher risk of serious and opportunistic infections in IBD patients (9) (10) (11) , that becomes particularly high in patients older than 50 years (12,13). Since it is expected that a same higher risk might occur in SARS-CoV-2, we believe that, at least temporarily, there is an urgent need to update the current recommendations for prebiological screening (14) . Knowledge of virus dynamics and host response is crucial to fully evaluate the impact of immunosuppressive therapies on the clinical course of COVID-19 in IBD patients and to provide management guidance to healthcare professionals. In conclusion, before starting biological therapy, until new data will be available, using a pragmatic approach, the physician should screen all patients for active COVID-19 by RT-PCR, even without clinical suspicion of infection. Thus, we suggest updating the common screening recommended prior to biological therapy in IBD patients ( We declare no competing interests. Asymptomatic carrier state, acute respiratory disease, and pneumonia due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2): Facts and myths Taking the right measures to control COVID-19 COVID-19: Gastrointestinal manifestations and potential fecaloral transmission Evidence for gastrointestinal infection of SARS-CoV-2 5. 1st Interview COVID-19 ECCO Taskforce. ECCO Crisis Task Force 2nd Interview COVID-19 ECCO Taskforce What Should Gastroenterologists and Patients Know About COVID-19? 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