Editorial: the impact of COVID on the management of IBD flares: different care but similar outcomes—authors' reply

We thank Haydek and Scott for their thoughtful editorial about our PREPAREIBD study.1,2 As they highlighted, there were reassuring signals regarding clinical outcomes during the pandemic despite the significant challenges faced by clinical teams. This suggests that further evaluation of the adaptations made in diagnostic, monitoring and treatment approaches will be useful, both as we learn to live with SARSCoV2 and in anticipation of future pandemics. We agree that the findings lend support to the increased use of noninvasive monitoring of IBD activity overall, which was able to guide treatment decisionmaking successfully in selected patients during the pandemic. Selfmonitoring strategies using faecal biomarkers are increasingly utilised in the management of IBD with a positive impact on compliance, while followup via telemedicine enables better use of finite clinical resources.3,4 However, it is important to note that many patients did need to undergo endoscopic and radiological assessment to guide a more stringent treattotarget strategy, even during the first wave. With COVID19 infection rates likely to rise over the winter, the potential for future pandemics, and IBD patients' natural concern about the risks of immunosuppression on infection and vaccine effectiveness, adaptations to flare management may be required again.5,6 Furthermore, staff sickness due to COVID19 infection may reduce the provision of invasive outpatient investigations. We welcome further studies to examine the benefit of prioritising medications with better safety profiles, particularly regarding the use of systemic corticosteroids. Studies from the United Kingdom have shown inappropriate and excess use of steroids in IBD patients, and our finding from the prepandemic group that 37.1% of patients with Crohn's disease flares and 40.1% of those with UC flares received oral prednisolone was surprising and concerning.7 This should further support the national and international efforts to facilitate prompt commencement of advanced steroidsparing therapies in appropriate patients.