COVID 19

Are we considered immunodeficient when it comes to the Coronaviras?

If immunomodulators/biologicals are the only way to get inflammation under control then that may outweigh the risk even with the coronavirus spreading around. But in light of this coronavirus I hope that the American Gastroenterological Association (AGA) reconsiders their recommendation for early use of “top down” biologic agents, and instead will recommend that UCers give mesalamines a fair shot to control the inflammation BEFORE escalating to those higher meds.

We have HW members here, and many others who no longer post here, who have maintained their remission for years on mesalamines alone. Even if mesalamines and rectal meds eventually do fail then there is always the option of moving up the meds ladder. But what are you supposed to do when the biologics fail? The probability of side effects increases when taking more than one immunosuppressant.

John is right. And I would be far more concerned about being on systemic steroids in the face of Covid-19 then I would be about biologics.

Also, I follow some Twitter feeds of well regarded IBD doctors and one stated that biologics are more concerning in the face of bacteria and fungal attacks and that viral agents are less of a problem.

iPoop said...
IAC has spent years fear-mongering about biologics, nothing new there

What “fear-mongering”? Please read what I actually wrote:
“If immunomodulators/biologicals are the only way to get inflammation under control then that may outweigh the risk even with the coronavirus spreading around.”

I also said that I hope the AGA would “recommend that UCers give mesalamines a fair shot to control their inflammation BEFORE escalating to those higher meds...
”We have HW members here, and many others who no longer post here, who have maintained their remission for years on mesalamines alone."

I have no problem at all with taking biologics if mesalamines fail to control inflammation. After all, this was the AGA's official recommendation of just a few years ago even before anyone ever heard of this coronavirus that is now spreading around the world:

https://www.ncbi.nlm.nih.gov/pmc/articles/pmc3264940/
Biologic agents and immunosuppressants are appropriate if patients have moderate-to-severe disease and have failed other standard therapies.

I know a lot of us are fearful of what UC patients should do with this whole COVID 19 thing (here on hw and other forums/sites), and the last thing anyone needs to do is perpetuate fear and amp up risks beyond their actual proportion. Taking any form of immunosuppression does increase our risks slightly but it is not certain doom, and they are not issuing bubbles for us to become bubble boys/girls lol. Let's say some of us do amp up the fear, uncertainty, and doubt in many posts related to this subject and it's hardly a baseless accusation (given the trail of locked posts). It's not helpful to amp up fears and scare others. Risks versus benefits are well established for our meds, and our doctors our the best source for that info.

As far as solid medical advice for IBD-specific patients and our meds the reliable information isn't wide spread. A good read on this.
https://www.ioibd.org/ioibd-update-on-covid19-for-patients-with-crohns-disease-and-ulcerative-colitis/

Key wording:

What are the current recommendations for IBD patients related to COVID19?
IBD is a condition of an overactive immune system, and is often treated with immune modification or immune suppression. IBD patients on immunosuppressive medications are in general, more susceptible to infection. Specifically, being on steroids or immune modulators like azathioprine or 6-mercaptopurine or methotrexate can increase an IBD patient’s risk for viral infections. To date, we don’t have specific IBD research on COVID19.

What are the current recommendations for IBD patients related to COVID19?
Many patients have already asked us if they should stop their medications. Medicines such as mesalamine (brand names include Asacol, Apriso, Balsalazide, Lialda, Pentasa) are all safe. It is always a good idea to get off of steroids such as prednisone/prednisilone, if this is possible. Thiopurines (6-mercaptopurine, azathioprine) and tofacitinib/xeljanz tend to inhibit the body’s immune response to viral infections. The thiopurines take months to leave the body. Thus stopping these will not help in the short term. The biologics we currently use to treat IBD such as anti-TNFs (Cimzia, Humira, Remicade, Simponi), ustekinumab (Stelara), vedolizumab (Entyvio) are generally safe. At present we do not recommend stopping these medications. Moreover, the effect of these medications stay in the body, in many cases, for months. We will keep updating these recommendations as more data become available.