- People with rheumatic disease taking certain immunosuppressive medications may have a lower risk of experiencing severe COVID-19.
- People taking TNF inhibitors were hospitalized less frequently than other COVID-19 patients with rheumatic disease.
- Immunosuppressants are being explored as COVID-19 treatments in people who don’t have a rheumatic disease.
Patients with rheumatic diseases who take certain medications may experience a milder course of COVID-19 if infected, new research shows. An analysis of a registry of patient data compiled by the Global Rheumatology Alliance suggests patients on some immunosuppressive medications are hospitalized for COVID-19 less frequently than people not taking those medications.
Despite the buzz surrounding it, hydroxychloroquine is not one of those medications.
Rheumatic diseases such as rheumatoid arthritis (RA) and lupus can be treated with biologics, a class of drugs that can be used for immunosuppression. According to the new research, three types of biologics may inhibit the cytokine storm—or overactive immune response—associated with severe cases of COVID-19:
- TNF inhibitors
- IL-6 inhibitors
- IL-1 inhibitors
“Patients with autoimmune connective tissue diseases who are on immunosuppressants have abnormal immune systems which predispose them to an increased risk of infections,” Jihan Saba, MD, FACR, a rheumatologist based in Fort Lauderdale, Florida, tells Get Meds Info. Saba is not currently involved with the registry. “However, in the case of COVID-19, patients on some immunosuppressive biologic therapies fared well in the Global Rheumatology Alliance registry, which is reassuring.”
Other Studies Support the Use of Immunosuppressants
The Global Rheumatology Alliance registry, which so far, includes physician-reported data from 4,293 patients as well as 13,363 patient survey responses, published its first COVID-19 paper in the Annals of the Rheumatic Diseases in May. That paper demonstrated that while prednisone (steroid) treatment seemed to increase the odds of hospitalization in rheumatic disease patients with COVID-19, TNF inhibitors lowered the risk.
Since then, more studies have highlighted how immunosuppressive drugs might be able to treat COVID-19 in patients whether or not they have a rheumatic disease.
A small French study published on August 11 looked at 12 patients with severe cases of COVID-19 who did not have a rheumatic disease. These patients were given anakinra, an IL1 inhibitor used in the treatment of RA. When administered intravenously, the drug was able to reduce fevers and systemic inflammation much more rapidly than treatments used in a control group, which mainly included antibiotics and hydroxychloroquine. This preliminary data suggests anakinra could be useful in larger settings.
While it’s not a biologic drug, the JAK inhibitor baricitinib is another immunosuppressive RA medication being evaluated for COVID-19. Researchers at the Karolinska Institute in Sweden were able to use baricitnib to dampen inflammation and reduce the viral load of SARS-CoV-2 in vitro, according to results published in August.
The Karolinska researchers also studied the effect of the drug on four patients hospitalized with COVID-19 in Italy. After treatment, these patients exhibited reduced symptoms of cough and fever, lower levels of inflammatory markers in their blood, and lower levels of SARS-CoV-2 RNA.
What This Means For You
If you have a rheumatic disease and an immunosuppressive medication is part of your treatment plan, you may be less susceptible to severe COVID-19. Further studies are needed to confirm this protective effect, and to explore the use of immunosuppressants in COVID-19 patients without rheumatic disease.
Data Does Not Support the Use of Hydroxychloroquine
Another important finding from the Global Rheumatology Alliance registry is that there is no difference in the recovery rates of patients on hydroxychloroquine versus patients not taking the drug. This medication, which is approved to treat RA, lupus, and malaria, was proposed as a possible therapy for COVID-19 in March. However, the Food and Drug Administration (FDA) ultimately revoked its emergency use authorization of hydroxychloroquine as a COVID-19 treatment in June, after data showed it was ineffective.
“The general population is claiming that hydroxychloroquine cures COVID-19 which is not true at all,” Micah Yu, MD, a rheumatologist at the Institute of Plant Based Medicine in Newport Beach, California, tells Get Meds Info. “If it were true, we would not have patients on hydroxychloroquine getting COVID-19. But rheumatic patients are still getting infected with COVID-19 and being hospitalized—even if they are on hydroxychloroquine.
Still, Yu is not rushing to suggest other RA medications to treat COVID-19.
“Medications, no matter how benign, still have side effects,” he says. “It is important for people to realize that.”
The information in this article is current as of the date listed, which means newer information may be available when you read this. For the most recent updates on COVID-19, visit our coronavirus news page.