An Important Message to Our Patients on Biologic and Anti-Rheumatic Drug Therapies
I have been urging all of you to continue your treatments despite concerns about the risk of contracting Covid-19. Discontinuation of medication may lead to a flare of your disease, which increases systemic inflammation, stresses the immune system, and increases susceptibility to infection. Many people turn to corticosteroids (prednisone) in this circumstance, but while that may help control your symptoms, steroids are even more dangerous in the setting of Covid-19.
Last week, the American College of Rheumatology came out with formal recommendations from their expert committee with respect to the management of patients on antirheumatic and biologic therapies and also emphasized that patients should continue their treatments and may actually face higher risk should they discontinue.
In our practice, we have not seen many Covid-19 infections in our patients. This is interesting because a number of the drugs we use, including Plaquenil and biologic agents are now being used to treat Covid-19! This is because these medications essentially work to “turn down the volume” of immune system activation which characterizes autoimmune disorders. And exaggerated immune system activation, or the “Cytokine storm” is what seems to be taking place in Covid-19 patients who become seriously ill.
Indeed, reports from China and elsewhere have indicated that that disease frequency and mortality in patients from rheumatic disease clinics taking various immunomodulating drugs seem to manifest a lower disease prevalence and mortality.
That said, should you contract Covid-19, you should discontinue your biologic medication, just as we do for influenza and other infections. But there is good reason to continue your treatment now as you continue to engage in social distancing and recommended safe practices to prevent coronavirus infection.