IBD management ‘has not changed in the era of COVID-19’
Click Here to Manage Email Alerts
With a risk for COVID-19 similar to the general population, patients with inflammatory bowel disease should be receiving the “same exact treatment” as they did prior to the pandemic, according to a presenter at the GUILD Conference.
“Are patients with IBD at increased risk for COVID-19? The answer is no,” Miguel Regueiro, MD, FACG, AGAF, chair of the Digestive Diseases and Surgery Institute at the Cleveland Clinic, told attendees. “This is the bottom line for many of our studies now: Patients with severe IBD, severe activity and those on high-dose steroids are probably the ones that are at more risk for COVID-19. Otherwise, we have not seen anything.”
Early in the pandemic, with insufficient data on the impact of immunosuppressive medications, Regueiro noted that the “knee-jerk reaction,” shared by both patients and providers, was to stop medication.
“It probably made us feel better to stop some of these therapies, but it takes a long time for some of these drugs to leave the body, and then the patients have more symptoms with their IBD,” Regueiro said. “What we saw early in the pandemic, at least in Cleveland, was higher rates of colectomy, of patients being hospitalized because they were stopping all of their medicines, simply because we were living in the time of COVID-19.”
Regueiro noted that although patients may experience more diarrhea and pain linked to a COVID-19 infection, interestingly, “we have not seen true flares or an exacerbation.” As with infection risk, Regueiro said that, overall, patients with IBD do not have worse outcomes following COVID-19; the high-risk groups for poor COVID-19 outcomes include older age, comorbidities such as obesity, moderate-to-severe IBD and high-dose corticosteroid use.
“To put it simply, I use the same exact treatment I did 3 years ago today,” Regueiro said. “I use my anticytokine therapies, I use small-molecules and I try to limit the amount of steroids I have patients on. My practice has not changed in the era of COVID-19. For patients who are SARS-CoV-2-negative, the bottom line is we are not changing our treatment and we are not changing our practice.”
However, treating patients with IBD who test positive for COVID-19 represents the “biggest change in my personal practice today,” Regueiro noted.
“If a patient is COVID-positive, the CDC recommendation is to hold immunosuppression, but I will tell you in my practice, if patients are positive without a high fever, I am not stopping my anticytokine or small-molecule therapies, and I tell my patients to watch for high fevers or respiratory compromise,” he said.
Regueiro noted that if the patient exhibits respiratory-compromise and high fevers, “obviously, we are going to withhold therapy until the patient improves. If a patient has a fever of 101.5 degrees or higher, I’ll wait for their fever to break. My rule of thumb now is 3 days after last fever, I will restart their therapy.”
Collapse
Regueiro M. Presentation: State of the Art — COVID and IBD: Lessons Learned. Presented at: GUILD 2022; Feb. 20-23, 2022 (hybrid meeting).
Read more about
Click Here to Manage Email Alerts