Many Chinese Patients Stopped IBD Meds During COVID-19 Pandemic

By Will Boggs MD

July 01, 2020

NEW YORK (Reuters Health) - Many patients stopped taking drugs for inflammatory bowel disease (IBD) during the COVID-19 pandemic in China, which often resulted in disease aggravation, according to a new study.

Most organizations have recommended continuation of IBD medications during the COVID-19 pandemic in patients not infected with the virus, but many have reportedly discontinued their medication nonetheless.

To get a better sense of how widespread the problem is, and its impact on outcomes, Dr. Min Zhi and colleagues at The Sixth Affiliated Hospital, Sun Yat-sen University, in Guangzhou, examined medical records of 386 IBD patients on maintenance therapy between January and April.

During this period, 107 IBD patients (27.7%) stopped their medication; of these, 50.5% discontinued biological agents, 17.8% discontinued immunosuppressants, 16.8% discontinued mesalazine, 3.7% discontinued glucocorticoids and 11.2% discontinued total enteral nutrition.

Most patients (86.9%) cited traffic restrictions and hospital regulations for infection prevention and control as reasons for discontinuation; 13.1% spontaneously discontinued medication due to the concern about COVID-19 infection or adverse drug reactions, the researchers report in Gastroenterology.

Nearly a quarter of patients with ulcerative colitis (22.7%) and 29.3% of those with Crohn's disease who discontinued their medication experienced aggravations of their disease.

While the authors' center provided guidance on IBD management remotely during the pandemic, they note that "the effect was not so satisfactory as we thought."

"Therefore," they conclude, "improvement is needed in information sharing, methods of drug purchase, adverse drug reaction monitoring, and feedback route for the management strategy of IBD. Telemedicine and community health services should also be promoted in the future."

Dr. Yezaz A. Ghouri of the University of Missouri-School of Medicine at Columbia, who recently reviewed the management of IBD in the wake of the COVID-19 pandemic, told Reuters Health by email, "As a GI specialist with the majority of my clinical care dedicated towards IBD patients, I personally have continued the majority of my patients on biologicals and other immunotherapies. Several IBD experts have recommended continuing biological therapies as long as patients do not have acquired SARS-CoV-2 infection."

"I think patient education and outreach definitely helps in preventing patients from discontinuing therapy by themselves without consulting with their GI specialist," he said.

"These are tough and challenging times for our immunocompromised IBD patients, who generally are well-informed about their disease state and therapies they are being administered," Dr. Ghouri said. "As a physician, I believe we should make adequate efforts to talk to our patients about their health concerns during the pandemic. Discuss the risks and benefits involved in any type of therapy they might be currently administered. Educate about COVID-19 and methods to prevent exposure and transmission of the infection."

Dr. Zhi did not respond to a request for comments.

SOURCE: Gastroenterology, online June 15, 2020.