Bourgonje Arno R, van Linschoten Reinier C A, West Rachel L, van Dijk Maarten A, van Leer-Buter Coretta C, Kats-Ugurlu Gursah, Pierik Marieke J, Festen Eleonora A M, Weersma Rinse K, Dijkstra Gerard
Department of Gastroenterology and Hepatology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, Groningen, 9700 RB, the Netherlands.
Department of Gastroenterology and Hepatology, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands.
Therap Adv Gastroenterol. 2021 Apr 29;14:17562848211012595. doi: 10.1177/17562848211012595. eCollection 2021.
In the wake of the coronavirus disease 2019 (COVID-19) pandemic, it is unclear how asymptomatic severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2)-infected patients who present with acute severe ulcerative colitis (UC) can be treated effectively and safely. Standard treatment regimens consist of steroids, immunomodulatory drugs, and biological therapies, but therapeutic decision-making becomes challenging as there are uncertainties about how to deal with these drugs in patients with COVID-19 and active UC. Importantly, guidelines for this particular group of patients with UC are still lacking. To inform therapeutic decision-making, we describe three consecutive cases of patients with active UC and COVID-19 and discuss their treatments based on theoretical knowledge, currently available evidence and clinical observations. Three patients were identified through our national inflammatory bowel disease network [Initiative on Crohn's and Colitis (ICC)] for whom diagnosis of SARS-CoV-2-infection was established by reverse transcription-polymerase chain reaction (RT-PCR) testing in nasopharynx, stools, and/or biopsies. Acute severe UC was diagnosed by clinical parameters, endoscopy, and histopathology. Clinical guidelines for SARS-CoV-2-negative patients advocate the use of steroids, calcineurin inhibitors, or tumor necrosis factor alpha (TNF-α)-antagonists as induction therapy, and experiences from the current three cases show that steroids and TNF-α-antagonists could also be used in patients with COVID-19. This could potentially be followed by TNF-α-antagonists, vedolizumab, or ustekinumab as maintenance therapy in these patients. Future research is warranted to investigate if, and which, immunomodulatory drugs should be used for COVID-19 patients that present with active UC. To answer this question, it is of utmost importance that future cases of patients with UC and COVID-19 are documented carefully in international registries, such as the SECURE-IBD registry.
在2019冠状病毒病（COVID-19）大流行之后，目前尚不清楚如何有效且安全地治疗出现急性重度溃疡性结肠炎（UC）的无症状严重急性呼吸综合征冠状病毒2（SARS-CoV-2）感染患者。标准治疗方案包括类固醇、免疫调节药物和生物疗法，但由于在COVID-19和活动性UC患者中如何使用这些药物存在不确定性，治疗决策变得具有挑战性。重要的是，针对这一特定UC患者群体的指南仍然缺乏。为指导治疗决策，我们描述了3例活动性UC合并COVID-19的连续病例，并根据理论知识、现有证据和临床观察讨论了他们的治疗情况。通过我们的全国炎症性肠病网络[克罗恩病和结肠炎倡议（ICC）]确定了3例患者，通过对鼻咽、粪便和/或活检组织进行逆转录-聚合酶链反应（RT-PCR）检测确诊为SARS-CoV-2感染。通过临床参数、内镜检查和组织病理学诊断为急性重度UC。SARS-CoV-2阴性患者的临床指南提倡使用类固醇、钙调神经磷酸酶抑制剂或肿瘤坏死因子α（TNF-α）拮抗剂作为诱导治疗，目前这3例病例的经验表明，类固醇和TNF-α拮抗剂也可用于COVID-19患者。这些患者随后可能接受TNF-α拮抗剂、维多珠单抗或乌司奴单抗作为维持治疗。未来有必要进行研究，以调查对于出现活动性UC的COVID-19患者是否以及应使用哪种免疫调节药物。为回答这个问题，至关重要的是，未来将UC合并COVID-19患者的病例在国际注册中心（如SECURE-IBD注册中心）进行仔细记录。
