Пульс - медицинский центр 
Пульс - медицинский центр
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The current COVID-19 pandemic caused by SARS-CoV-2 has become a global health emergency. Treatment of chronic inflammatory bowel disease (CIBD) according to the standards includes the use of 5-aminosalicylic acid (5-ASA), corticosteroids, cytostatics, and biological therapy. However, these treatments can weaken the immune system, which potentially puts COPD patients at increased risk of infections and infectious diseases, including COVID-19. Therefore, patients with CVD have a greater risk of developing COVID-19 and more severe clinical course, or even death, compared to the general population.
При переходе к биологической терапии необходимо рассмотреть возможность подкожного введения, чтобы ограничить контакт пациента с медицинским учреждением. Выборочный переход от внутривенных инфузий инфликсимаба к препаратам анти-TNF с подкожным введением не рекомендуется, поскольку это может увеличить риск рецидива. Если пациент находится в контакте с человеком COVID-19, необходимо рассмотреть возможность отказа от терапии анти-TNF в течение 2 недель. Если у пациента положительный результат теста на SARS-CoV-2 и/или у него развивается COVID-19, необходимо рассмотреть возможность отказа от биопрепаратов до тех пор пока пациент не избавится от инфекции.
Treatment with corticosteroids (especially prednisolone ≥20 mg/day or equivalent) is associated with an increased risk of infection. However, it is unclear whether corticosteroid therapy is associated with an increased risk of developing COVID-19 or its complications. Data on budesonide, a topical corticosteroid with low systemic bioavailability, show that these drugs are associated with significantly fewer side effects compared to systemic corticosteroids and their side effects are close to placebo. If possible, corticosteroids should be avoided and a rapid dose reduction considered, and a switch to budesonide is recommended. This must be taken into account, taking into account the risk of exacerbation of CKD. If a patient with COPD is in contact with a person with COVID-19 or develops COVID-19, it is recommended to gradually reduce the dose of corticosteroids, the use of budesonide is preferred, but taking into account the severity of COPD and the risk of exacerbation.
If a patient tests positive for SARS-CoV-2 and/or develops COVID-19, discontinuation of biologics should be considered until the patient clears the infection. JAK inhibitors (tofacitinib and others) selectively affect the intracellular JAK/STAT signaling system, which mediates the action of many cytokines involved in the pathogenesis of ulcerative colitis. Unlike genetically engineered biological drugs, inhibition
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