key: cord-1051207-ugrgmuds
authors: Zingone, Fabiana; Buda, Andrea; Savarino, Edoardo Vincenzo
title: Starting a Biologic Therapy in IBD Patients Amid COVID-19: Hold, Careful Monitoring, or Testing?
date: 2020-05-19
journal: J Crohns Colitis
DOI: 10.1093/ecco-jcc/jjaa102
sha: e9c2c41c9d12fd57c8ba3bc0f7f77985e172aeac
doc_id: 1051207
cord_uid: ugrgmuds

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Also, an Italian study of a series of consecutive IBD patients who developed COVID-19 reported that nearly one-third was hospitalised, with an overall mortality rate of 8%. 3 These figures of negative outcome are in stark contrast to the relatively low infection rate. Thus, as the cases grow worldwide, we believe that particularly caution should be applied in order to prevent complications derived from COVID-19 infection in our IBD patients, especially when treated with immunosuppressive medications.

Although current data do not show an increased risk of negative outcome with concomitant use of immunosuppressive drugs, starting new biologic treatment during the COVID-19 pandemic can be of specific concern to IBD health care professionals. Should we screen IBD patients for COVID-19 infection before starting immunosuppressive therapy? As with many other aspects of COVID-19, data needed to answer this question are limited and currently specific clinical guidance or recommendations are lacking. IBD scientific societies suggest postponing the start of biologic treatment, but there are patients with particularly aggressive clinical flares [i.e. severe ulcerative colitis] who must undergo expeditious treatment. Since this pandemic is unlikely to be quickly contained and delay in biologic therapy initiation in IBD is associated with higher odds of adverse outcomes, indefinite postponement is not a feasible option.

Considering the reported mortality rate due to COVID-19 infection, the frequent chance of absence of respiratory symptoms in patients carrying the virus, the risk of infections, and the potential of a more aggressive course associated with immunosuppressive drugs, 4 we believe that all IBD patients in whom immunosuppressive treatment cannot be delayed should undergo screening for SARS-COV-2 virus active infection, particularly before receiving biologic therapy. 5 Whether the assessment of immunisation status for effective triage in these patients, and in those already on biologic or immunomodulatory treatment, should be introduced is another crucial clinical question that needs to be addressed in future months.

None.

Are patients with inflammatory bowel disease at increased risk for COVID-19 infection?

Surveillance Epidemiology of Coronavirus Under Research Exclusion

Outcomes of COVID-19 in 79 patients with IBD in Italy: an IG-IBD study

Comparative risk of serious infections with biologic and/or immunosuppressive therapy in patients with inflammatory bowel diseases: a systematic review and meta-analysis

Screening for active COVID-19 infection and immunization status prior to biologic therapy in IBD patients at the time of the pandemic outbreak. Dig Liver Dis

Nothing to declare.

FZ, AB, ES: critical review of manuscript, drafting, and finalisation of the manuscript.