Review of inflammatory bowel disease and COVID-19

Table 2 Continued summary of expert opinions and guidelines

	General recommendations	Serious COVID-19 disease risk: Highest risk	Moderate risk	Lowest risk
BSG	Continue current medications; Avoid corticosteroids if possible Observe “shielding” while prednisone dose ≥ 20 mg daily; Initiation of IMM monotherapy not advised; Consider stopping thiopurines in older patients or those with significant comorbidity who are in sustained remission; Consider monotherapy with anti-TNF; Consider adalimumab over infliximab to promote home care; Early use of therapeutic drug monitoring; Do not recommend switching from IV to S/C	IBD and a comorbidity; Hypertension Diabetes; Age ≥ 70 yr; AND one from “Moderate Risk” column OR; Moderate to severely active disease; ≥ 20 mg prednisolone or equivalent; New biologic < 6 wk; Moderate to severely active disease NOT controlled on Moderate risk Rx; Short bowel syndrome ON nutritional support; Requirement for Parenteral nutrition	Anti-TNF monotherapy; Biologic plus immunomodulator in stable patients; Ustekinumab; Vedolizumab; Thiopurines; Methotrexate; Calcineurin inhibitors (tacrolimus or ciclosporin); Janus kinase inhibitors (tofacitinib); Immunosuppressive trial medication; Mycophenolate mofetil; Thalidomide; Prednisolone < 20 mg or equivalent per day	5-ASA users; Rectal therapies; Orally administered topically acting steroids (budesonide or beclometasone); Therapies for bile acid diarrhoea (cholestyramine, colesevelam, colestipol); Antidiarrhoeals (e.g., loperamide); Antibiotics for bacterial overgrowth or perianal disease
CCF	Stay on your medications; Do not skip infusion appointments; Consider rescheduling non urgent endoscopic procedures

COVID-19: Coronavirus disease 2019; BSG: British society of gastroenterology; IBD: Inflammatory bowel disease; TNF: Tumor Necrosis Factor; IMM: Immunomodulators; ASA: Aminosalicylic acids; CCF: Crohn’s and colitis foundation.