Management of inflammatory bowel disease in the COVID-19 era

Kim, Kyeong Ok; Jang, Byung Ik

doi:10.5217/ir.2020.00156

Cited by 22 publications

(25 citation statements)

References 70 publications

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“…Although there are still limited data on the safety of IBD drugs, all experts and societies recommend continuing IBD-specific treatment since it has been recognized that the risk of active disease is higher than the uncertain risk of immunosuppression, which tends to increase the risk of COVID-19. 8,[19][20][21] Although early data have reported that combination therapy and thiopurine monotherapy may be associated with a higher risk of severe COVID-19 infection in IBD patients, 22 supporting evidence regarding the discontinuation of thiopurine in patients on stable maintenance is still very weak. 19,20 Considering that only 7% of patients discussed the safety of their drugs with medical staff, we also need to pay attention to the effect of the lack of communication between patients and the medical staff.…”

Section: Discussionmentioning

confidence: 99%

“…8,[19][20][21] Although early data have reported that combination therapy and thiopurine monotherapy may be associated with a higher risk of severe COVID-19 infection in IBD patients, 22 supporting evidence regarding the discontinuation of thiopurine in patients on stable maintenance is still very weak. 19,20 Considering that only 7% of patients discussed the safety of their drugs with medical staff, we also need to pay attention to the effect of the lack of communication between patients and the medical staff. Neglecting treatment due to misinformation can exacerbate IBD.…”

Section: Discussionmentioning

confidence: 99%

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Perceptions and Behaviors of Patients with Inflammatory Bowel Disease during the COVID-19 Crisis

Lee

Kim

et al. 2022

Gut and Liver

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Background/Aims: This study aimed to investigate the perceptions and behaviors of patients with inflammatory bowel disease (IBD) during the early coronavirus disease 2019 (COVID-19) pandemic in the major epidemic area in Korea.Methods: Between April and May 2020, a cross-sectional survey was performed at two tertiary hospitals in Daegu, South Korea, on patients' experiences, coping strategies and perceptions.Results: Most of the 544 patients participating in the survey strictly adhered to personal protection guidance against COVID-19. In the early COVID-19 crisis, many patients canceled or postponed hospital visits (57.5%) and rescheduled biologics administrations (26.4%). Although 13.6% utilized telemedicine, the frequency of individuals leaving their homes remained unchanged. Although 50.4% were concerned about their susceptibility to COVID-19, 72.2% adhered to their treatment for IBD. In patients taking biologics or Janus kinase inhibitors, 86.8% disagreed that they should discontinue their medication as a preventative measure against CO-VID-19, but 21.9% actually discontinued their medications. Of those with discordance between the perception of IBD drug adherence and active behaviors, 5.4% of all and 39.4% of biologics or Janus kinase inhibitors withheld drugs specifically due to fear of COVID-19. Only 7% of all patients discussed drug safety with their physicians. The level of concern for COVID-19 depended on the type of drug used. Conclusions:Patients with IBD showed concerns about the increased risk of COVID-19 due to IBD or their medications, and a considerable number of patients withheld their medications without consulting medical staff. Enhanced active communications with patients with IBD and appropriate health-related education should be provided.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Perceptions and Behaviors of Patients with Inflammatory Bowel Disease during the COVID-19 Crisis

Lee

Kim

et al. 2022

Gut and Liver

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“…The precautions that should be taken for steroid therapy could be minimize their use, avoid starting new therapies, and taper down the dose if it is higher than 20 mg/day of prednisolone or equivalent, always taking into account the disease activity. In case of acute, severe form of UC, corticosteroid treatment could be started after urgent molecular swab or after excluding COVID-like symptoms [ 9 ].…”

Section: Drugs and Inflammatory Bowel Diseases: What Have We Learned?mentioning

confidence: 99%

“…In these patients, there is also an increased expression of ACE2 in the gut mucosa [ 7 ] and an increase of ACE2 serum levels (as well as Ang1–7 and the ACE2: ACE ratio) [ 8 ]. This could play a protective role in the blood [ 9 ] by acting as a competitive receptor for the virus and thus leading to the reduction of the viral load that would infect the host.…”

Section: Introductionmentioning

confidence: 99%

Risk, Course, and Effect of SARS-CoV-2 Infection in Children and Adults with Chronic Inflammatory Bowel Diseases

et al. 2021

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Susceptibility and disease course of COVID-19 among patients with inflammatory bowel diseases (IBD) are unclear and epidemiological data on the topic are still limited. There is some concern that patients with immuno-mediated diseases such as IBD, which are frequently treated with immunosuppressive therapies, may have an increased risk of SARS-CoV-2 infection with its related serious adverse outcomes, including intensive care unit (ICU) admission and death. Corticosteroids, immunomodulators, and biologic drugs, which are commonly prescribed to these patients, have been associated with higher rates of severe viral and bacterial infections including influenza and pneumonia. It is not known whether these drugs can be so harmful as to justify their interruption during COVID-19 infection or if, on the contrary, patients with IBD can benefit from them. As shown by recent reports, it cannot be excluded that drugs that suppress the immune system can block the characteristic cytokine storm of severe forms of COVID-19 and consequently reduce mortality. Another cause for concern is the up-regulation of angiotensin converting enzyme-2 (ACE2) receptors that has been noticed in these patients, which could facilitate the entry and replication of SARS-CoV-2. The aim of this narrative review is to clarify the susceptibility of SARS-CoV-2 infection in patients with IBD, the clinical characteristics of patients who contract the infection, and the relationship between the severity of COVID-19 and immunosuppressive treatment.

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“… 5 6 Patients with IBD are reported to be at no greater risk of contracting COVID-19 than the general population. 7 8 There have been no confirmed cases of IBD patients with confirmed COVID-19 in Korea yet. This case series reports on COVID-19 confirmed IBD patients' clinical features and characteristics in Korea.…”

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confidence: 99%

Clinical Course of COVID-19 in Patients with Inflammatory Bowel Disease in Korea: a KASID Multicenter Study

et al. 2021

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In 2020, the novel coronavirus disease 2019 (COVID-19) began to spread worldwide and remains an ongoing medical challenge. This case series reports on the clinical features and characteristics of patients with inflammatory bowel disease (IBD) and confirmed COVID-19 infection. From February 2020 to March 2021, nine patients with IBD had confirmed COVID-19 across four hospitals in Korea. The median age at COVID-19 diagnosis was 42 years. Six patients were male, and seven patients had ulcerative colitis (UC). No patients required oxygen therapy, intensive care unit hospitalizations, or died. The most common symptom was fever, and gastrointestinal (GI) symptoms developed as diarrhea in five patients with UC. Oral steroids were used to combat UC aggravation in two patients. In this case series of nine IBD patients diagnosed with COVID-19 in Korea, the clinical presentation was predominately a mild respiratory tract infection. Most patients with UC developed new GI symptoms including diarrhea.

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Management of inflammatory bowel disease in the COVID-19 era

Cited by 22 publications

References 70 publications

Perceptions and Behaviors of Patients with Inflammatory Bowel Disease during the COVID-19 Crisis

Perceptions and Behaviors of Patients with Inflammatory Bowel Disease during the COVID-19 Crisis

Risk, Course, and Effect of SARS-CoV-2 Infection in Children and Adults with Chronic Inflammatory Bowel Diseases

Clinical Course of COVID-19 in Patients with Inflammatory Bowel Disease in Korea: a KASID Multicenter Study

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