Dear Editor, we have read with interest the comments to our article [
[1]
] by Prentice et al. [[2]
]. The authors mainly underlined the potential harms associated with asymptomatic screening for SARS CoV-2 prior to commencement of biologic therapies in IBD patients without a strong evidence base to dictate subsequent practice on the return of a positive test.We agree that available data do not strongly support an increased risk of contracting COVID-19 infection in IBD patients or a higher risk to develop complications in case of infection. On the other hand, there are studies suggesting a case fatality rate of 8% and a hospitalization rate of 28% among 79 IBD patients with confirmed COVID-19 followed-up at 24 IBD referral units [
[3]
]. Moreover, data from the SECURE registry observed that 7% of patients with IBD may develop severe COVID-19, 31% are at risk of hospitalization, and there is a 3% case fatality rate [[4]
]. These numbers suggest that until our understanding on the impact of SARS CoV-2 on IBD will improve, a prudential strategy should be pursued in order to limit unnecessary risks for our patients [[5]
,[6]
. In keeping, the last ECCO taskforce, providing guidance on the most appropriate care to adopt during the pandemic, confirms the need to test all IBD patients for SARS-CoV-2 if there is the need to start biologics for an IBD flare, particularly if glucocorticoids are already taken by the subjects [[7]
].Second, the authors expressed concerns about the possibility that COVID-19 testing could result in delaying biologic treatment and therefore perpetuating IBD disease activity and systemic corticosteroid use. From our perspective, it is difficult to understand how a rapid oropharyngeal swab test (less than 24 hours) or serological test (less than 6 hours) could delay the start of treatment, particularly considering that screening examinations (i.e. latent tuberculosis infection testing) carried out in parallel may require days before obtaining the final results. Thus, testing time should not be part of the problem in this particular setting.
Third, the authors pointed out the suboptimal accuracy of serological tests for SARS CoV-2 detection. We acknowledged the current limitation of this diagnostic method and, indeed, our screening algorithm recommends the use of nasopharyngeal swab, while serological antibody tests should be a useful supplement to RNA or antigen detection. On the other hand, serological test may provide further insights of the kinetics on the virus and additional data to implement strategies for preventing transmission and diffusion of the infection.
In conclusion, we believe that after about 6 months from COVID-19 outbreak, our knowledge is still limited and therefore we should continue to manage our patients with caution, trying to avoid complications and make informed decisions. Thus, we still believe that all patients should be tested for SARS-COV-2 by oropharyngeal swab before starting immunosuppressive (and immunomodulatory) therapies.
Authors contribution
- Fabiana Zingone, MD, PhD: design of the study, writing of the manuscript, approving final version
- Andrea Buda, MD: design of the study, writing of the manuscript, approving final version
- Edoardo Savarino, MD, PhD: design of the study, writing of the manuscript, approving final version
Financial support
none
Potential competing interests
none
References
- Screening for active COVID-19 infection and immunization status prior to biologic therapy in IBD patients at the time of the pandemic outbreak.Dig Liver Dis. 2020; 52: 604-605
- Asymptomatic Screening for SARS CoV-2 prior to commencement of biologic therapies in patients with Inflammatory Bowel Disease - a potentially harmful practice.DLD. 2020;
- Outcomes of COVID-19 in 79 patients with IBD in Italy: an IG-IBD study.Gut. 2020; 69: 1213-1217
- Corticosteroids, But Not TNF Antagonists, Are Associated With Adverse COVID-19 Outcomes in Patients With Inflammatory Bowel Diseases: results From an International Registry.Gastroenterology. 2020 Aug; 159: 481-491.e3
- Starting a biologic therapy in IBD patients amidst COVID-19: hold, careful monitoring or testing?.J Crohns Colitis. 2020 May 19; : jjaa102
- Viral screening before initiation of biologics in patients with inflammatory bowel disease during the COVID-19 outbreak.Lancet Gastroenterol Hepatol. Jun 2020; 5: 525
- Inflammatory bowel disease management during the COVID-19 outbreak: the 10 do's and don'ts from the ECCO-COVID Taskforce.J Crohns Colitis. 2020 Jul 29; : jjaa160
Article info
Publication history
Published online: September 26, 2020
Accepted:
September 22,
2020
Received:
September 20,
2020
Identification
Copyright
© 2020 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.
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- Asymptomatic screening for SARS CoV-2 prior to commencement of biologic therapies in patients with inflammatory bowel disease - a potentially harmful practice.Digestive and Liver DiseaseVol. 52Issue 11
- PreviewWe read with interest the recent publication by Zingone et al “Screening for active COVID-19 infection and immunization status prior to biologic therapy in IBD patients at the time of the pandemic outbreak” [1]. They advocate for screening all patients with inflammatory bowel disease (IBD) for SARS CoV-2 prior to commencement of biologic agents with the use of both IgM and IgG antibodies and nasopharyngeal PCR testing, intending to identify both current infection with, and previous exposure to, the virus [1].
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