Guidance for Restarting Inflammatory Bowel Disease Therapy in Patients Who Withheld Immunosuppressant Medications During COVID-19

J Crohns Colitis. 2020 Oct 21;14(Supplement_3):S769-S773. doi: 10.1093/ecco-jcc/jjaa135.

Corey A Siegel 1, Britt Christensen 2, Asher Kornbluth 3, Joel R Rosh 4, Michael D Kappelman 5, Ryan C Ungaro 3, Douglas Forsyth Johnson 6, Scott Chapman 7, David A Wohl 8, Gerassimos J Mantzaris 9


Author information

  • 1Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock IBD Center, Lebanon, NH, USA.
  • 2Gastroenterology Department, Royal Melbourne Hospital, Melbourne, VIC, Australia.
  • 3Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
  • 4Division of Pediatric Gastroenterology, Goryeb Children's Hospital, Morristown, NJ, USA.
  • 5Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
  • 6Departments of Infectious Diseases and Internal Medicine, Royal Melbourne Hospital, Melbourne, VIC, Australia.
  • 7Department of Infectious Diseases, St Vincent's Hospital, Sydney, NSW, Australia.
  • 8Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
  • 9Department of Gastroenterology, Evaggelismos-Ophthalmiatreion Athinon-Polykliniki GHA, Athens, Greece.


Patients with inflammatory bowel diseases [IBD] are frequently treated with immunosuppressant medications. During the coronavirus disease 2019 [COVID-19] pandemic, recommendations for IBD management have included that patients should stay on their immunosuppressant medications if they are not infected with the severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2], but to temporarily hold these medications if symptomatic with COVID-19 or asymptomatic but have tested positive for SARS-CoV-2. As more IBD patients are infected globally, it is important to also understand how to manage IBD medications during convalescence while an individual with IBD is recovering from COVID-19. In this review, we address the differences between a test-based versus a symptoms-based strategy as related to COVID-19, and offer recommendations on when it is appropriate to consider restarting IBD therapy in patients testing positive for SARS-CoV-2 or with clinical symptoms consistent with COVID-19. In general, we recommend a symptoms-based approach, due to the current lack of confidence in the accuracy of available testing and the clinical significance of prolonged detection of virus via molecular testing.

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