Patients on immunosuppressive therapy are not at increased risk for contracting COVID-19

Henry Ford Health SystemSep 15 2020

Patients on immunosuppressive therapy for common skin and rheumatic diseases like psoriasis and rheumatoid arthritis are not at increased risk for contracting COVID-19 and should continue taking their medicine as prescribed, say Henry Ford Health System dermatology researchers in a study published in the Journal of the American Academy of Dermatology.

Most of these patients are not at any greater risk for COVID-19 than the general population, despite their weakened immune system, says Jesse Veenstra, M.D., Ph.D., a Henry Ford dermatologist and the study's lead author. He says the findings should reassure patients and doctors alike.

If you require an immune suppressant medication for your condition to be well controlled, you should not be afraid to continue that medication during the pandemic."

Jesse Veenstra, MD, PhD,Study Lead Author and Dermatologist, Henry Ford Health System

The study is one of the first to analyze the association between immunosuppressive medications for skin diseases and the risk of COVID-19 infection and outcomes.

Until recently, little was known about managing patients on these medications in the pandemic and whether they may be at increased risk for infection with COVID-19 or related complications because of their weakened immune system.

Dr. Veenstra and his research colleagues conducted a retrospective analysis of 213 patients who were taking immunosuppressive medication for an immune-mediated inflammatory disease.

The patients were tested for COVID-19 between Feb. 1 and April 18 and had been receiving immunosuppressive medication for at least one month prior to being tested for COVID-19.

Key findings from their analysis:

• Of the 213 patients, 36% tested COVID-19 positive and had no greater odds of being hospitalized or placed on a ventilator than the general population.

• There was no evidence that any single immunosuppressive medication increased a patient's odds for testing positive or developing serious disease.

• Race was a predictor for COVID-19 status, with African Americans having greater odds of testing positive.

• Patients prescribed a TNF alpha inhibitor had significantly lower odds for hospitalization. TNF alpha inhibitors are part of a class of immunosuppressive biologics used to stop inflammation.

Conversely, Dr. Veenstra says, patients who were on multidrug therapy regimens were at greater odds of being hospitalized than those taking a single medication.

Dr. Veenstra says more research is needed to fully explain this finding, but it may suggest that multiple medications further suppress a patient's immune system, thus rendering them more susceptible to COVID-19.

Generally, patients who are immunosuppressed are predisposed to upper respiratory infections like the common cold, which may cause coughing, a runny nose and a sore throat.

To date, however, this patient population has not been reported to be at higher risk for COVID-19. Older adults and people with underlying medical conditions like cancer, COPD and diabetes are considered high risk for contracting the coronavirus.

"Physicians who prescribe these medications should feel comfortable either continuing or resuming their patients on these medications," Dr. Veenstra says. "They can counsel their patients that there's data to support the safety profile of these medications during the COVID-19 pandemic."

Henry Ford dermatologists treat one of the largest patient populations in Michigan for inflammatory skin diseases like psoriasis, eczema and lupus, prompting researchers to examine whether the immunosuppressive medications made patients more susceptible to the new, emerging coronavirus.

"Traditionally, you think of these medications putting you at higher risk for infection," Dr. Veenstra says. "With COVID, this is a new type of pathogen, and no one really knows how these medications affect your immune system's ability to deal with the infection. The question is, do these medications put you at greater risk for contracting COVID, and if you did get it, would you be sicker because of these medicaitons."