key: cord-0919931-jiboy3ql
authors: Amin, Rajan; Thomas, Anusha S; Khurana, Shruti; Panneerselvam, Kavea; Zou, Fangwen; Ma, Weijie; Chari, Suresh T; Wang, Yinghong
title: Management of Immune-Related Colitis During the COVID-19 Pandemic
date: 2020-08-19
journal: Inflamm Bowel Dis
DOI: 10.1093/ibd/izaa235
sha: 6e6d5a81c8b5c5df84123cefa681ba73aa583dc3
doc_id: 919931
cord_uid: jiboy3ql

nan

To the Editors,

The coronavirus disease 2019 pandemic continues to plague the world since it was first detected in December 2019. Immunocompromised patients, including those with cancer, are at increased risk of severe illness and mortality from infection. 1 Immune checkpoint inhibitors have revolutionized cancer management but can also trigger an immune response leading to immune-related adverse events affecting multiple organ systems, including the gastrointestinal tract. Treatment with immunosuppressive therapies is usually required for a prolonged period of time. 2 Inflammatory bowel disease is characterized by immune-mediated chronic inflammation of the gastrointestinal tract and bears a significant similarity to immune-mediated diarrhea and colitis (IMDC) in presentation and management. It remains unanswered as to whether gut inflammation and therapeutic immunosuppression for IMDC can increase the risk for COVID-19 infection and its related complications.

We report a retrospective review of all patients with cancer evaluated by gastroenterologists at our institution for IMDC from December 1, 2019, to April 30, 2020. Medical records were reviewed and telephone surveys were conducted among 69 patients who met the criteria; 43 patients completed the survey. Table 1 summarizes the survey results, focusing on the risk factors and protective measures related to COVID-19 infection. We found that 86% of patients always wore a mask when leaving home, 74% washed their hands more than 10 times daily, and 84% had less than 4 close contacts with nonhousehold individuals on weekly basis. Of note, 36 patients had confirmed negative COVID-19 tests. Among the patients without testing, there was no concern for COVID-19 to prompt testing during the study period.

We identified several factors that may have contributed to the low infection rate of COVID-19 among our patients with IMDC. First, we observed high levels of compliance with effective preventive measures 3 of social distancing and wearing masks in this population. Second, most of our cohort resided in Texas, which was not the hot-spot of COVID-19 during the study window. Finally, immunosuppression may mitigate the cytokine release syndrome associated with severe COVID-19 infection based on recent evidence. 4 We speculate that this factor may have contributed to the lack of overt clinical manifestations of infection among asymptomatic patients who were not tested for COVID-19. This study was limited by patient selfrecall relating to adherence to preventive measures.

Based on our overall findings, we do not believe that the concern for COVID-19 should negatively affect optimal management of IMDC with immunosuppressive therapy as long as protective measures such as social distancing and wearing masks are emphasized and adequately implemented. Other states include Mississippi, Arkansas, Florida, and Alabama. ‡ Self-reported data from patient surveys.

Patients with cancer appear more vulnerable to SARS-COV-2: a multicenter study during the COVID-19 outbreak

National Comprehensive Cancer Network. Management of immune-related adverse events in patients treated with immune checkpoint inhibitor therapy

Evaluating the effectiveness of social distancing interventions to delay or flatten the epidemic curve of coronavirus disease

Use of corticosteroids in coronavirus disease 2019 pneumonia: a systematic review of the literature