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COVID-19 in relation to our IBD population

The novel strain of coronavirus, known as severe acute respiratory syndrome coronavirus 2 (SARSCoV2) was first detected in Wuhan, China and causes the disease known as COVID-19. Our knowledge about this disease is evolving and additional recommendations are constantly being updated. For the most up to date information, check the CDC and WHO websites.

Because this is a novel virus strain, our only experience with it and its effect on patients with IBD comes from the reported cases so far. The first case of coronavirus disease 2019 (COVID-19) was reported in December of 2019, so our knowledge is limited.

It is important to know that although IBD is a disorder of the immune system, patients with IBD are not innately immunosuppressed. IBD patients who are treated with immunosuppressants are in general more susceptible to infection and therefore are at higher risk of getting very sick from this illness. The common immunosuppressants and Biologics in IBD include prednisone, 6-mercaptopurine, azathioprine, methotrexate, infliximab (Remicade, Inflectra, Renflexis), adalimumab (Humira), certolizumab (Cimzia), golimumab (Simponi), ustekinumab (Stelara), vedolizumab (Entyvio), natalizumab (Tysabri), tofacitinib (Xeljanz) and study biologics including upadacitinib and risankizumab. Elderly patients with IBD as well as pregnant IBD patients are also at increased risk. Anyone with additional underlying medical conditions such as heart disease and diabetes is also considered at increased risk.

IBD patients on mesalamine should continue to follow the CDC and the Public health Department’s guidance related to events and travel. Use of mesalamine does not cause immunosuppression and does not place the patient in a higher risk category.

Individuals in high risk groups (those on immunosuppressants) are being advised to take extra precautions. <taken from CDC page>

  • Stock up on supplies.
  • Take everyday precautions to keep space between yourself and others.
  • When you go out in public, keep away from others who are sick, limit close contact and wash your hands often.
  • Avoid crowds as much as possible.
  • Avoid cruise travel and non-essential air travel.
  • During a COVID-19 outbreak in your community, stay home as much as possible to further reduce your risk of being exposed.

Our recommendations for all IBD patients is to continue their medical therapy, as staying in remission is paramount at this time. If you have any concerns, please talk to your primary gastroenterologist. The FDA is closely monitoring the medical supply chain, and so far, no shortage is reported on medications used to treat IBD.

If you are taking steroids (prednisone) for any reason, discuss with your health care provider options to lower your dose or get off steroids altogether. Although immunomodulators like thiopurines (azathioprine, 6-mercaptopurine), cyclosporine, methotrexate and the JAK inhibitor tofacitinib (Xeljanz) tend to inhibit the body’s immune response to viral infections, discontinuation is not recommended. Thiopurines take months to leave the body and stopping them will not help in the short-term.

Reminders for all patients

A list of publications referenced by the CDC can be found here: https://www.cdc.gov/coronavirus/2019-ncov/publications.html  

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