123: Immunosuppressants, Biologic Medications + Coronavirus - Are You More At Risk?

“Am I at greater risk of getting really sick from the Coronavirus because of the medication I’m taking?”

It’s a good question.

Especially because many people who suffer from severe skin rash conditions like atopic dermatitis and psoriasis may be on immunosuppressants or biologic medications.

I’ve seen this question posed a number of times online and it’s something I wondered myself.

Unfortunately, there isn’t much direction provided to our skin rash community even from the big advocacy organizations at this point.

I figured that I’d start asking around to help you get a straight answer.

In today’s episode, I’m sharing the response that I got from a Healthy Skin Show guest Dr. Peter Lio and an official statement from one organization.

Plus I’ve got a list of medications that could be a concern so you know whether it’s time to give your doctor a call.

Or, listen on your favorite app: iTunes (Apple Podcasts) | Spotify | Stitcher | TuneIn | Subscribe on Android

In this episode:

• Should you worry about your risk of getting the Coronavirus if you’re on immunosuppressants or biologic drugs?
• Statement from Dr. Peter Lio on the matter
• Lists of immunosuppressant + TNF inhibitor drugs
• What you should do if you’re taking one of these medications

Quotes:

Do not just stop medication without the guidance of your physician just because you read online that it could make you susceptible.

The International Psoriasis Council officially recommends that “physicians discontinue or postpone use of immunosuppressant medications.”

Immunosuppressants & Biologic Medications: Are You More At Risk For Coronavirus? (FULL TRANSCRIPT)

Welcome back to episode #123 of the Healthy Skin Show!

In today’s episode, I want to answer your question (or shall I saw fear) about being at greater risk for the Coronavirus (COVID-19) if you’re on immunosuppressant or biologic medication.

I’ve actually seen this question a lot online in various Facebook groups, and frankly, I was curious myself!

Hopefully, you’re fully aware that COVID-19 is a big deal.

It’s now officially deemed a global pandemic by WHO with confirmed cases in all 50 states of the US as of the date this podcast airs.(1,2)

No matter where you live, people are starting to get nervous (and some are pretty panicked).

In my own county outside of Philadelphia, we are currently on lockdown with schools, universities, and non-essential businesses closed. Residents have been asked to stay home for a 14-day period.

This was triggered because a doctor tested positive after seeing a number of patients locally and then a local police officer became infected.(3,4) And unfortunately, the number has continued to grow.

So if you’ve thought this was no big deal, I urge you to reconsider.

Do not dismiss this as simply another cold or flu. 

Or worse yet, do not think COVID-19 is a hoax. (You can read more about what’s going on in Italy thanks to my friend Ambra living in Cremona here and what she has to say to people not taking this seriously.)

Nor should you assume that you’re not at risk because you’re younger.

Though the risk of death increases with age and other health issues, there are younger, healthy people in very serious condition with COVID-19.

And you also have to think about others in your community who are immunocompromised, battling cancer, living with organ transplants, and also the elderly.

What could end up just being a couple of weeks not feeling well for you, could very well be life-ending for other people.

How Could COVID-19 Impact People With Chronic Skin Rash Conditions?

Naturally, people are nervous and asking questions online about how COVID-19 could impact them.

Heck, I’m doing the same exact thing!

The reality is that we aren’t always getting more helpful information with the 24-hour news cycle focused predominantly on reporting new cases.

Fortunately, I’m in contact with doctors who have been able to provide me some valuable insight.

Some of these colleagues are currently doing a ton of research on the virus while others are in touch with physicians working on the front lines in outbreak areas.

Like you, I wondered those who are most vulnerable.

Especially given that some in our community are on biologic or immunosuppressant medications for eczema, psoriasis and other chronic skin rash conditions.

The concern is very real, especially for these immunocompromised individuals.

Though I’ve found a bit of guidance online, I decided to reach out to some experts we’ve had on the show to get their two cents to share with you.

Dr. Peter Lio’s Response On Coronavirus, Immunosuppressant + Biologic Medications

So here is my exact question that I sent Dr. Peter Lio (one of our favorite recurring guests on the Healthy Skin Show)…

“I've gotten a lot of questions and concerns from listeners who are on biologic drugs like Dupixent or Humira about the COVID-19 virus.

Do you know if someone taking these are at a greater risk of getting really sick from the virus?”

And here is Dr. Peter Lio’s unedited response that he gave me permission to share with you all:

“Hi Jen,

This is a key question for sure!

While there is no official guidance yet, we feel pretty good about the more targeted biologic agents such as dupilumab, tremfya, cosentyx, etc. I'm a little more concerned about the TNF inhibitors such as Humira, though even those are not as worrisome as the true immunosuppressants such as cyclosporine, azathioprine, and methotrexate.

As the modern biologics do not deeply or fully suppress the immune system, we think that the risk is probably not much greater than for those not on these medications. In fact, there are some studies looking at actually using some anti-inflammatory approaches to minimize the severe inflammatory reaction from the coronavirus–it may actually prove to be helpful in protecting some patients!

At this time, I'm not changing anyone who is truly in need of these, but I am trying wean down my patients on conventional immunosuppressants such as cyclosporine when possible.”

I am so greatly appreciative that I could share this response from you all at such a critical time. If you’ve been worried about this, I hope this response helps you rather than becoming unnecessarily afraid.

Drugs That Could Be A Concern For The Coronavirus

As you know, I’m not a doctor.

Though I am lucky enough to be able to share information like this with you, what I (and even Dr. Lio) share is for information purposes only.

Ultimately you need to speak with your doctor in order to determine the right course of action for you.

Do not just stop medication without the guidance of your physician just because you read online that it could make you susceptible.

Generally speaking, some medications should not be stopped cold turkey (I know this from past experience in my early 20s taking an SSRI). That’s why you must work with your doctor.

That said, it is clear that there is a concern present for people taking tumor necrosis factor (TNF) inhibitors and immunosuppressants.

But as I sat and thought about Dr. Lio’s email, I realized that you might not know what drugs fall into which class.

TNF inhibitors include(5):

• Humira (Adalimumab)
• Embrel (Etanercept)
• Remicade (Inflixmab)
• Simponi (Golimumab)
• Cimzia (Certolizumab Pegol)

Immunosuppressants include(6,7):

• Methotrexate
• Cyclosporine
• Azathioprine
• Mycophenolate
• Tacrolimus (used topically in atopic dermatitis)

The International Psoriasis Council has officially recommended that “For psoriasis patients diagnosed with COVID-19 disease, physicians discontinue or postpone use of immunosuppressant medications” as of March 11, 2020.(8)

As of the date of this podcast, I could not find any statement on the use of these medications from the National Eczema Association, International Eczema Council nor the National Psoriasis Foundation websites.

Your Next Steps For Your Health + The Coronavirus

For every single listener…

If you’re wondering what to do, here’s what I suggest:

No matter how many (or few) confirmed cases exist in your area, stay at home. This is the best option for us all. Cancel your travel plans and stay at home for at least the next two weeks.

I cannot stress how important it is to follow the directions and requests provided by your local government.

I realize what I’m asking, but we have to do this to stop the spread of the coronavirus.

If you are on any medications for your skin rashes, make a list of your concerns.

Then call your doctor and speak with them directly to get answers.

And remember… your case is not someone else’s.

Even if someone using the same medication as you posts online that their doctor recommended a certain course of action, that doesn’t mean it’s right for you.

You are different from them and your case is unique.

It’s not to say that you can’t ask the doctor about what you’ve read and if they feel that would apply to you — always ask.

Frankly, I feel like we’ve woken up in some weird sci-fi movie, but this is our reality right now. And we have an opportunity to make smart choices, but it’s imperative that we act decisively!

I hope this information is helpful to you.

If you know anyone using these drugs, or you’re a part of an online group where you can share this information, it’s imperative that you SHARE THIS EPISODE!

We must help each other stay informed in this rapidly changing environment with accurate information to keep those most at risk safe.

And I’d love to hear your thoughts on this topic!

Leave your comments and thoughts below on COVID-19 and what you’re doing to keep yourself healthy.

I’ve got more information coming soon on the show to help you support healthier skin even during this crazy time!

In the meantime, I wish you good health in the coming days as we stay home and take care of ourselves and our community.

Thank you for tuning in and I’ll see you in the next episode!

REFERENCES

1. https://time.com/5791661/who-coronavirus-pandemic-declaration/
2. https://www.nytimes.com/interactive/2020/us/coronavirus-us-cases.html
3. https://www.inquirer.com/health/coronavirus/coronavirus-covid19-chop-king-of-prussia-cardiologist-philadelphia-hup-20200309.html
4. https://www.nbcphiladelphia.com/news/health/lower-providence-employee-tests-positive-for-new-coronavirus/2322676/
5. https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/information-tumor-necrosis-factor-tnf-blockers-marketed-remicade-enbrel-humira-cimzia-and-simponi
6. https://nationaleczema.org/eczema/treatment/immunosuppressants/
7. https://www.ajmc.com/insights/biologics-treatment-adolescent-atopic-derm/ad-management-with-immunosuppressants
8. https://www.psoriasiscouncil.org/blog/Statement-on-COVID-19-and-Psoriasis.htm