Are immunosuppressive treatments safe during the COVID-19 pandemic?

This review highlights the current literature and best practice guidelines on the use of immunosuppression in the time of the COVID-19 pandemic.

Summary

Cases from the previous SARS and MERS outbreaks do not indicate an elevated risk of severe disease with immunosuppression. In the current pandemic, there has been a growing body of case reports, case series and retrospective reviews assessing patients on various immunosuppression regimens for organ transplants or immunological disease. The rate of COVID-19 infection and disease course in these patients is similar to the general population and appears to be consistent in Chinese, Italian and pediatric populations.

Currently, the International Uveitis Study Group (IUSG), International Ocular inflammation Society and Foster Ocular Inflammation Society recommend continued immunosuppression in patients without clinical signs of COVID-19 infection. They also recommend tapering corticosteroids as quickly as possible to 20 mg daily or less, practicing social isolation for stable patients and following up with patients with active uveitis to adjust medications. For control of flares, they advise intraocular therapy instead of high-dose corticosteroids. If a patient is suspected to have COVID-19, all biologics medication—with the exception of interferon and IL-6 blockers—should be stopped until signs of recovery and they should also be tested for the virus. Patients on nonbiologic immunosuppressants can continue treatments with close monitoring.

Limitations

Since these findings are retrospective and limited by the fact that the pandemic is evolving, understanding of COVID-19 transmission, disease course and treatment will continue to change.

Clinical significance

Thus far, evidence suggests patients with ocular inflammatory disease can remain on immunosuppression. However, high-dose systemic corticosteroids should be avoided.