Guideline

GUIDELINES

Patients already on a biological agent and in remission

Continue on same biological agent

Patients considering new combination therapy (e.g. thiopurine and infliximab)

Consider monotherapy biological agents for the initial period during the pandemic, in view of increased immunosuppression with combination therapy

Switching from an IV biologic (e.g. infliximab) to a subcutaneous biologic (e.g. adalimumab)

No switching if there is good response to the original drug, except in extenuating circumstances when infusion centers are not available

Switching from one class of biological therapy (e.g. anti-TNF agent) to another (e.g. non anti-TNF agent)

Currently there is no evidence that any one particular class of biological agents is safer than another

Dose reduction (if deemed necessary)

Consider in an appropriate patient who has recent documented mucosal healing

Stopping biological agents

Patients should fulfil the same criteria for stopping biological agents as during non-pandemic times

No evidence of increased risk of COVID-19 infection
Consider initiation with monotherapy (therefore consider adalimumab to promote home care and lower risk of immunogenicity relative to infliximab)

No evidence of increased risk of COVID-19 infection
Initiation of monotherapy is not advised
Combination therapy with biologics should be made on careful discussion of risk and benefit on a case-case basis
Older patients (>65 y) or those with significant comorbidity, in sustained remission on thiopurines should consider stopping after appropriate discussion with their doctor

Should be avoided if possible. Rapid tapering (10mg/week) should be considered where possible
Should not be stopped suddenly without advice
Consider using budesonide MMX (9 mg/day 8 weeks) or beclometasone (5mg/day 4 weeks) for flaring UC patients (important to assess after 2 weeks)