As the COVID-19 global pandemic grows with the UK, active inflammatory bowel disease (IBD) patients could be at a higher risk, as patients using prominent therapies such as Remicade and Humira could cause an increased risk of bacterial and viral infections, says GlobalData, a leading data and analytics company. In order to protect active IBD patients, the British Society of Gastroenterology (BSG) has published a consensus for the management of IBD patients during the pandemic.
Patrick Aiyes, Senior Healthcare Analyst at GlobalData comments: “The BSG consensus advice for the management of IBD during the COVID-19 pandemic suggests patients with severe symptoms will continue to be assessed in a location away from COVID-19 assessment areas. However, in order to reduce traffic in outpatient clinics, mild IBD patients will be deferred to a telemedicine system, which will be adopted to conduct appointments and review new IBD patients. Furthermore, biomarker and endoscopy testing will be limited due to the presence of the virus in stool. While these measures would help alleviate the pressures on hospital beds and allow more space for COVID-19 sufferers, IBD patients who progress from moderate to more severe disease face a possibility of being ignored if telemedicine systems aren’t efficient.”
On behalf of the BSG, a UK-wide COVID-19 group has defined IBD patient risk for COVID-19 into three subsets, which are the highest risk, moderate risk and lowest risk. Shielding is recommended for patients who could be classified as the highest risk from COVID-19; this means those who are extremely vulnerable should minimize contact with other members of their household and should not leave their homes. Most patients who suffer from IBD will usually be classified into the moderate or lowest risk groups, which suggests self-isolation (staying at home and only leaving for essential purposes) and social distancing (maintaining a two-meter distance from other people), respectively. However, patients who are above 70 years old and/or have at least one comorbidity such as respiratory conditions, cardiac conditions, hypertension, or diabetes mellitus are classified as the highest risk group.
This leaves IBD patients looking for information on how to handle their treatment during COVID-19.
Aiyes continues on this issue, “Physicians have maintained that patients should continue their medications and will maintain access to intravenous treatment in order to prevent flares and the formation of anti-drug antibodies.
“A review from the World Health Organization (WHO) shows that corticosteroids are not recommended for use in viral conditions as they could possibly promote pro-inflammatory responses, which could worsen the viral disease. Prominent biological therapies such as Remicade, Humira, and Stelara in IBD could enhance the risk of bacterial and viral infections, as these drugs inhibit the function of cytokines, which could help the immune system against COVID-19; however, there is no concrete evidence of these therapies increasing the risk of infection.”
As IBD patients face some uncertainty around the use of biologics, this could affect their adherence to and uptake of these therapies. Doctors may also be reluctant to start mild to moderate patients on these treatments. IBD patients and doctors must make informed decisions on how to handle treatments going forward during COVID-19.