Practice Patterns of Medical Management of Inflammatory Bowel Disease During Pandemic of COVID-19: A Global Survey of Health Care Providers

Abstract

Background: Patients with inflammatory bowel disease (IBD) are susceptible to viral infection, which may include SARS-CoV-2. The management of IBD and COVID-19 can be challenging, as the majority of patients are on some immunosuppressive medications. The aim of this study is to identify practice patterns, management strategy, and outcomes of IBD and COVID-19 with a world-wide survey of health care providers.

Methods: The 22-item survey questionnaires were sent to the IBD community worldwide, including health care providers of IBD from epicenter countries at different time points, such as China, the United States, and Spain. Fifty IBD clinicians outside China were invited for the survey. The survey was sent to members of China Crohn’s and Colitis Foundation as a web blast.

Results: Of 192 respondents (39 from outside China, 153 from China), 95 (49.5%) were IBD specialists or IBD colorectal surgeons. Thirty clinicians (15.6%) reported encountering COVID-19 patients during the pandemic, including 18 (9.4%) and 12 (5.2%) who cared for Crohn’s disease (CD) patients and ulcerative colitis (UC) patients with COVID-19, respectively. A majority of clinicians (N=152, 79.2%) believed that screening for SARS-CoV-2 was henceforth necessary before the initiation of biological therapy. Forty-two (21.9%) clinicians reported that they have switched infused biologics to an injectable biologic during the outbreak. Since the outbreak, 77 (40.1%) clinicians initiated systemic corticosteroids; 78 (40.6%) initiated immunomodulators; and 120 (62.5%) initiated biologics. Most clinicians [120/181 (66.3%)] recommended the continuation of corticosteroids or immunomodulators in all their IBD patients. Seventy-nine clinicians (43.6%) continued biologics in all their patients during the pandemic. One hundred and forty-seven (81.2%) respondents reported IBD flare-up of at least some of their patients and 106 reported IBD flare-up after continuation of immunosuppressive medications (ISM) (i.e. corticosteroids, immunomodulators, or biologics). One hundred and six (52.1%) reported disease progression of their IBD patients (i.e. IBD-related emergency room visit, hospitalization, or surgery) while continuing ISM; and 92 (47.9%) reported disease progression of IBD after discontinuing ISMs. Further analysis showed that continuation of ISMs or initiation of biologics during the pandemic were not associated with the increased number of patients with disease flare-up or progression. Of the 30 clinicians encountering COVID-19, 13 (43.3%) reported that their patients were not on corticosteroids; 14 (46.6%) reported that none of their patients were on immunomodulators; 13 (43.3%) reported that none of their patients was on any biologics. Three clinician reported COVID-19-associated deaths.

Conclusions: Continued use of ISM was common in IBD clinicians during the outbreak. IBD patients can develop COVID-19 in the absence of the use of ISM. More than half of surveyed clinicians continued biologics and even initiated therapy during the pandemic. On the other hand, one third to close to one half of clinicians discontinued ISMs and none of them noticed any of their patients with disease flare or progression. The majority of clinicians recommended future screening for SARS-CoV-2 before the initiation of biological therapy.

Funding Statement: None.

Declaration of Interests: Dr. Yan Chen: None. Dr. Song Xu: None. Dr. Garrett Lawlor: Research grants for IBD fellowship from Janssen and Abbvie. Dr. Charles Bernstein: Has served on advisory boards for Abbvie Canada, Roche Canada, Janssen Canada, Takeda Canada, Pfizer Canada, consulted to Mylan Pharmaceuticals, has received educational grants from Abbvie Canada, Pfizer Canada, Takeda Canada, and Janssen Canada and has been on the speaker’s panel for Janssen Canada, Abbvie Canada, Medtronic Canada, and Takeda Canada. Dr. Francis A. Farraye: Consultant for BMS, Braintree Labs, Gilead, GSK, Innovation Pharmaceuticals, Janssen, Pfizer and Sebela. He sits on a DSMB for Lilly and Theravance. Dr. Marietta Iacucci: Research grant from Pentax, Olympus and Fujifilm. Consultant and speaker for Pentax, Abbvie and Jansen. Dr. Joseph Picoraro: No disclosure. Dr. Cindy Zhu: No financial conflicts of interest. Dr. Ravi P. Kiran: No disclosures. Dr. Bo Shen: consultant and speaker for Abbvie, Janssen, and Takeda,

Ethics Approval Statement: The central institutional review board of study was approved by the ethics committee of the 2nd Hospital of Zhejiang University.