Expert Opinions on the Current Therapeutic Management of Inflammatory Bowel Disease during the COVID-19 Pandemic: Japan IBD COVID-19 Taskforce, Intractable Diseases, the Health and Labor Sciences Research

Abstract

Background The COVID-19 pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has emerged as a dramatic challenge for all healthcare systems worldwide. This outbreak immediately affected gastroenterologists as well as global physicians worldwide because COVID-19 can be associated with not only triggering respiratory inflammation but also gastrointestinal (GI) inflammation based on the mechanism by which SARS-CoV-2 enters cells via its receptor the angiotensin-converting enzyme 2, which is expressed on GI cells. However, the comorbidity spectrum of digestive system in patients with COVID-19 remains unknown. Because the inflammatory bowel disease (IBD) management involves treating uncontrolled inflammation with immune-based therapies, physicians, and patients have great concern about whether IBD patients are more susceptible to SARS-CoV-2 infection and have worsened disease courses. Summary It is necessary to precisely ascertain the risk of SARS-CoV-2 infection and the COVID-19 severity in IBD patients and to acknowledge the IBD management during the COVID-19 pandemic with clinically reliable information from COVID-19 cohorts and IBD experts' opinions. In this review, we highlight clinical questions regarding IBD management during the COVID-19 pandemic and make comments corresponding to each question based on recent publications. Key Messages We propose that there is (1) no evidence that IBD itself increases the risk of SARS-CoV-2 infection, (2) to basically prioritize the control of disease activity of IBD, (3) no need for physicians to suddenly discontinue immunomodulatory or biologic therapy in patients with quiescent IBD, and (4) a need for careful observation of elderly (>60 years old) and IBD patients receiving corticosteroid treatment during the COVID-19 pandemic.

Quality of life in patients with IBD during the COVID-19 pandemic in the Netherlands

“…During the pandemic, healthcare measures in different disciplines were taken to facilitate the intensive care Open access capacity for patients with COVID-19, while at the same time non-COVID-19 care was minimalised to reduce the pressure on healthcare. [1][2][3][4][5][6][7][8][9][10] A recent study describes a decrease in IBD care performed as a result of the pandemic. 22 Due to changes in the healthcare priority, the HRQoL of the patients with IBD may have decreased.…”

“…Open access changes in medical treatment and diagnostic procedures for patients with IBD were made. [4][5][6][7][8][9][10] Therefore, non-urgent care, including treatment of patients with IBD, has a lower healthcare priority. Furthermore, basic measures were taken in the Netherlands to reduce the spread of COVID-19, including the advice to stay at home if possible and to limit the number of social contacts.…”

Granulocyte and monocyte apheresis therapy for patients with active ulcerative colitis associated with COVID-19: a case report

“…3 For the treatment of patients with UC that relapses with moderate or worse symptoms despite the use of 5-ASA, systemic steroid therapy is usually the first choice, 5,6 but the treatment choices for a patient with both active IBD and COVID-19 are limited because immunosuppression therapy is not recommended in principle. 2,3 Especially in patients with IBD, steroids have been noted to pose a risk of worsening concomitant COVID-19. 7 GMA is adsorbed by activated myeloid cells into the extracorporeal circulation by an Adacolumn ® filled with cellulose acetate beads.…”

“…2,3 Several treatment guidelines have been proposed for patients with IBD and coexisting COVID-19, but the treatment options for active IBD are very limited because immunosuppression therapy is essentially not recommended. 2,3 Adsorptive granulocyte and monocyte apheresis (GMA) with an Adacolumn ® device has been established as an extracorporeal circulating www.irjournal.org concomitantly, but there was no remission in the patient's symptoms. He developed severe fatigue and a fever of 38°C during the course of treatment.…”

What Do Influenza and COVID-19 Represent for Patients With Inflammatory Bowel Disease?

“…According to Nakase et al, there is still no evidence that IBD itself can augment the risk of SARS-CoV-2 infection; and, for these reasons, there is no need for doctors to suddenly discontinue immunomodulatory or biologic treatment in quiescent IBD subjects. Besides that, there is a need for careful observation of older age patients (> 60 years old) and those subjects receiving corticosteroid therapy during the COVID-19 pandemic [ 77 ].…”