Joint Research Office


Immune suppressing drugs not linked to increase in risks from COVID-19

10 June 2020

Patients on immunosuppressive medications for rheumatic and musculoskeletal diseases such as arthritis and lupus can be reassured that these drugs do not increase the risks posed by COVID-19, according to researchers.

Researchers studied this question and presented results at a June meeting of the European League Against Rheumatism (EULAR).

It has been unclear whether these drugs – designed to suppress an overactive immune response which damages the body – may increase the risk of experiencing a severe course of disease in the case of infection with the novel coronavirus, and patients have expressed concern over this.

But researchers, including senior co-author Dr Pedro Machado of UCLH and UCL, found medications including conventional disease-modifying antirheumatic drugs (csDMARDs) – such as anti-malarial drugs or methotrexate – alone or in combination with other drugs – and nonsteroidal anti-inflammatory drugs (NSAIDs) were not associated with hospitalisation in patients.

In addition, intake of TNF-alpha inhibitors – commonly used in rheumatoid arthritis – was associated with a reduced probability of hospitalisation.

Researchers analysed 600 patients from 40 countries and investigated the impact of the choice of rheumatic disease therapy on potential hospitalisation and the course of COVID-19.

The only exception to their finding was steroids: researchers found that treatment with more than 10mg of the steroid prednisone per day – corresponding to a moderate to high dose – was associated with a higher probability of hospitalisation. Prednisone is frequently used in rheumatology as a fast-acting anti-inflammatory drug.

But researchers said caution should be taken when interpreting this finding, as patients taking moderate to high doses of steroids are likely to be sicker.

Dr Machado said: “Steroids were the only exception we found to our encouraging results, and we think the greater chance of hospitalisation found in patients taking these doses might be explained by their sickness itself, rather than the steroids. So patients on steroids should not stop or reduce their dose on the basis of our findings.”

Dr Machado said further research is necessary, both to clarify the link between steroids and outcomes, and to more deeply understand the course of COVID-19 in patients with rheumatic conditions overall.

Watch and read Dr Machado discuss the results in more detail.