TABLE 1

Treatment of patients with inflammatory bowel disease and COVID-19 (as of July 2020)

Severity COVID-19	Treatment
Mild Outpatient Patient hospitalized without hypoxia or pneumonia	Continue 5-ASA, rectal therapies, budesonide Hold tofacitinib, methotrexate, and thiopurines^a Taper corticosteroids and/or switch to budesonide Delay biologics for 2 weeks or until COVID-19 resolves^a Individualize each patient: Weigh risks and benefits of COVID and IBD treatment. A patient with severe IBD may require treatment irrespective of COVID-19
Moderate Hospitalized patient with hypoxia Radiographic signs of pneumonia	Treat COVID-19 as per local guidelines Continue 5-ASA, rectal therapies, budesonide Hold tofacitinib, methotrexate, and thiopurines^a Taper corticosteroids and/or switch to budesonide Delay biologics for 2 weeks or until COVID-19 resolves^a
Severe Patient requires mechanical ventilation or vasopressor therapy End-organ damage	Treat COVID-19 as per local guidelines Continue 5-ASA, rectal therapies, budesonide Hold tofacitinib, methotrexate and thiopurines^a Taper corticosteroids and/or switch to budesonide Delay biologics for 2 weeks or until COVID-19 resolves^a
^aConsiderations for restarting therapy: If asymptomatic: wait at least 10 days since date of first positive COVID-19 test. If symptomatic: wait at least 10 days since COVID-19 symptom onset and at least 3 days since recovery (defined as resolution of fever and improvement in respiratory symptoms). In severe COVID-19, a longer time frame may be necessary.

AGA = American Gastroenterological Association; ASA = aminosalicylates; IBD = inflammatory bowel disease; IOIBD = International Organization for the Study of Inflammatory Bowel Disease
Adapted from the AGA¹⁷ and IOIBD recommendations.¹⁸