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BSG webinar: COVID-19 and the Gut & the risk rationale of shielding / Annual General Meeting

This webinar, recorded on the 15th June 2020, is designed for BSG members and features interactive sessions on:

  • Shielding advice for IBD and hepatology patients led by Dr Ian Arnott and Prof Phil Newsome
  • Emerging science around COVID-19 and the Gut led by Prof Mark Beattie

As we were unable to hold our traditional AGM this year, the final part of this virtual event is the first online BSG AGM, featuring the official Presidential Handover, as well as the presentation of the Annual Report and Accounts.

 

Questions from the webinar

We hope these are useful additions to the webinar replay. As a uniquely challenging time for the medical profession, the BSG is working hard to offer support and guidance for members. Please refer to the COVID-19 Advice section to view the latest guidance.

 

Question Answer
What is the view on starting new patients on biologics in the current situation? The evidence is that biological therapies do not represent an excess risk of severe disease with COVID-19 infections. Steroids and active IBD are risk factors. Therefore we think that new patients should be started on biological therapies at the current time when clinically appropriate. Services should ensure that they are able to ensure an ongoing supply of drug, ideally via a homecare service for subcutaneous drugs. It is also essential that services are able to provide adequate follow and monitoring.
How will shielding advice change as new COVID cases decline? One of the key factors in how governments will advise on ‘behaviours’ for the CEV group, will be the level of COVID-19 community infection. Reliable data will need to be available on this informed by widespread population testing.

It is likely in the longer term that individuals will need help through ‘shared decision making’ to assess their individual risk / benefit profile for any given level of infection, accepting that there is likely to be at least a COVID -19 second wave in the UK with at present an absence of specific treatments and a vaccine.

BSG is working with the RCP to ensure that

1) We are part of the medical specialties CEV group which acts as a communication channel between government departments
2) Our advice is aligned and timely and regularly reviewed: some variation on specific immunosuppressive drug combinations may vary based on disease specific factors for any one specialty cohort and prescribing habits.

BSG COVID -19 specific guidance is for the duration of the pandemic but will be updated and re-issued as data emerge. Regular review of all guidance is being overseen by the BSG Executive

What further risk tools are being developed for IBD? The risk tools being developed nationally are generic. The web tool developed for IBD (by Dr Nick Kennedy with the IBD Registry and the BSG) was a specific app for IBD patients to assess their own risk using the parameters in the BSG Risk Grid produced for health care professionals. By using the App as well as providing a risk status for each patient, the data was uploaded via NHS digital to ensure patients in the Clinically Extremely Vulnerable ( CEV) group were offered shielding.
In the current situation, when treating a patient with exacerbation of IBD, should we use biologics instead of using IV hydrocortisone? The treatment of acute severe UC should continue to follow the current BSG guidelines. There is no evidence to support biologics as first line therapy in this situation. It is obviously important to remember that gut symptoms can be the presenting feature of COVID-19 in 10% of patients and thus patients who are admitted with ASUC should have a side room and be tested on admission and at key decision points in their treatment. The RAND panel analysis that has been recently published in GUT has some very sensible guidance on the management of this patient group.
For IBD patients who need escalation of treatment, are biologics preferred over Thiopurine? Many services are favouring the use of biologics over thiopurines at the moment but there is relatively little data available to support this. The evidence again does not suggest worse COVID-19 outcomes in those treated with thiopurines but the data is not perfect. There will be a selection and reporting bias and it is unlikely that the numbers reported are sufficiently large to highlight differences. I personally have been using a lot of biologics in this situation.
What is the evidence for risk of COVID-19 for patients with immunosuppression or liver disease? Unpublished data from the NHSBT indicate transplant patients are at increased risk.
It appears that only stable PBC and PSC patients do not need shielding and every other patient with liver disease needs shielding. This has huge implications for our patient cohort. When will these guidelines be reviewed and updated? Guidelines will be reviewed on a regular basis.
Many patients on immunosuppressants are concerned about their risk – within this group what are the factors that individual clinicians will consider when deciding whether they should shield – is there any further advice that we can give patients in this group about their risk? The known factors will increase risk as will the burden of immunosuppressive medications and the degree of liver fibrosis