How to manage inflammatory bowel disease during the COVID-19 pandemic: A guide for the practicing clinician

Table 4 Management of patient with inflammatory bowel disease hospitalized with severe coronavirus disease 2019[12,19,20,26,27]

	Management
Quiescent IBD	(1) Budesonide, aminosalycilates, and rectal therapy may be kept; (2) Taper or withdraw prednisone; (3) Stop immunomodulators, tofacitinib, and biologics; and (4) Prioritize life support; consultation with infectious diseases expert for possible COVID-19 treatment with antiviral or experimental anticitokine therapy; thromboprophylaxis
Mildly active IBD	(1) Budesonide, aminosalycilates, and rectal therapy may be initiated; (2) Taper or withdraw prednisone; (3) Non starting or stopping if in use biologics, immunomodulators, and tofacitinib; and (4) Prioritize life support; consultation with infectious diseases expert for possible COVID-19 treatment with antiviral or experimental anticitokine therapy; thromboprophylaxis
Moderately to severely active IBD	(1) Limited use of intravenous steroids for IBD if necessary; (2) Topical therapy may be initiated if needed; (3) Quit immunomodulators, tofacitinib, or biologics that failed for the IBD; and (4) Consider other therapies for IBD only if absolutely necessary; intravenous cyclosporine may be a reasonable option for ulcerative colitis, based on limited evidence of its benefit against coronavirus. Prioritize life support; consultation with infectious diseases expert for possible COVID-19 treatment with antiviral or experimental anticitokine therapy; thromboprophylaxis

Immunomodulators refer to thiopurines and methotrexate. IBD: Inflammatory bowel disease; COVID-19: Coronavirus disease 2019; Severe COVID-19: Patient with systemic hyperinflammation syndrome needing mechanical ventilation ± vasopressors or evidence of end organ damage.