Review of inflammatory bowel disease and COVID-19

Table 1 Summary of expert opinions and guidelines

Organization	IBD treatment, stable disease (No known or suspected COVID-19)		Known or suspected COVID-19
Chinese IBD Society	May continue anti-TNF; May continue vedolizumab; May continue ustekinumab but avoid new IV infusion initiation (to avoid infusion center); Discourage new tofacitinib use in endemic areas; Discourage new or increased dose of immunosuppressant; Postpone elective surgery or endoscopy		Contact physician for temperature over 38 C; Hold immunosuppressant and biologic agents for suspected COVID-19
		SARS-CoV-2 positive testing (without COVID-19 disease)	SARS-CoV-2 positive testing (with COVID-19 disease)
IOIBD	Continue infusions (if center has COVID-19 testing protocol); Reduce or DC prednisone (but not other therapies); Treat moderate to severe IBD (new or relapsing disease) with same therapies as pre-COVID-19; Postpone elective procedures	Uncertain if need to stop anti-TNF; Uncertain if need to stop ustekinumab; Stop tofacitinib; (IBD medications can be restarted after 14 d if the patient has not developed COVID-19)	Stop anti-TNF, ustekinumab, tofacitinib; Stop IMM if on combination therapy; Uncertain if need to stop vedolizumab; (IBD medications stopped may be restarted after COVID-19 symptoms resolve and/or after 2 nasopharyngeal PCR tests are negative
AGA	Continue current IBD therapies; Continue infusions at appropriate infusion centers; Only perform urgent or emergent procedures	Hold thiopurines, methotrexate, and tofacitinib; Delay biologic therapy for 2 wk while monitoring for COVID-19 symptoms	Hold thiopurines, methotrexate, tofacitinib, and biological therapies; (IBD medications may be restarted after complete symptom resolution or when follow up viral testing is negative or serology demonstrates convalescent stage

IBD: Inflammatory bowel disease; COVID-19: Coronavirus disease 2019; TNF: Tumor necrosis factor; SARS-CoV-2: Severe acute respiratory syndrome coronavirus 2; IOIBD: International Organization for the Study of Inflammatory Bowel Disease; DC: Discontinue; IMM: Immunomodulators; AGA: American Gastroenterological Association.