Thread by @IBDMD

I've created a thread that summarizes the statements from the #IOIBD global expert panel about management of #IBD during #COVID19. This is because the meeting summary of _appropriateness_ statements is being a bit misunderstood.
doi.org/10.1053/j.gast…
Read on ⬇️⬇️
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First, a disclaimer! The statements by this expert panel are not meant to replace conversations between a patient and their healthcare providers, nor are they set in stone. As we learn more, there will be modifications provided.
▶️IOIBD is holding weekly calls about #COVID19.
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A RAND panel is a formal assessment of specific given statements when decision making is complex and data are limited.
The #IOIBD panel included 66 #IBD experts from 26 countries who voted on the "appropriateness" of specific statements using a 9 point scale. Example ⬇️
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The results of the international panel voting on a statement are summarized as "Appropriate" "Uncertain" or "Inappropriate" based on the MEDIAN response.
But also, a "disagreement index" is calculated to demonstrate the spread of responses.
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So, the way to interpret this is that our group of #IBD experts may have been in agreement about a statement being appropriate or not, and at other times, although the median vote rendered a statement appropriate or not, there may have been broader disagreement by the group.
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One more thing: When the group's vote was "uncertain", that reflected that either the group didn't know enough to render the statement appropriate or not, or that the statement was too complex or layered to render it appropriate or inappropriate.
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Here's the methodology of this RAND panel:
-Statements created by a few of us
-First vote
-Webinar to discuss available data, results of first round of voting.
-Statements modified.
-Repeat voting of modified statements.
-Comparison of pre/post webinar disagreement indices.
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The sign of an effective process is the movement of some of the votes more solidly into appropriate/inappropriate (either!) areas and more agreement amongst the participants.
This RAND panel was an effective process. ⬇️
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Alright, alright, let's get to the summary. Reminder that I do encourage you to read the manuscript to learn more.
Also in the supplemental material is the actual survey instrument. doi.org/10.1053/j.gast…
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Assessment and management of risks in the #IBD population:
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5-ASA therapies:
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Oral budesonide:
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Oral prednisone ≥20 mg/day:
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Azathioprine/6-mercaptopurine and methotrexate:
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Anti-TNF therapies:
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Vedolizumab (anti-integrin) therapy:
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Ustekinumab (anti-IL12 and anti-IL23) therapy:
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Tofacitinib (JAK inhibitor) therapy:
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What about combination therapy of an anti-TNF and immunomodulator? (it's complicated):
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When to consider restarting therapy?
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What else did we cover?
▶️clinical trials
▶️infusion centers (make sure they have a screening protocol and adequate prevention plans)
▶️available info about infection and IBD therapies

Please read the full manuscript for more.
21/21 fin

doi.org/10.1053/j.gast…