Are you taking these prescription drugs? That might mean you’re higher risk for COVID-19

Medical Disclaimer: It is important to note that scientists are still actively working to understand COVID-19, and there is much we do not know about the disease. Therefore, all of the below information is subject to change as new research comes out regarding the disease. Additionally, nothing in this article is meant to suggest either A) you will definitely get COVID-19 if you have an autoimmune condition and/or taking immunosuppressant medications or B) you will NOT get COVID-19 if you follow the below immune system lifestyle changes. 

Your immune system is responsible for fighting off infections, including viruses such as COVID-19. You are considered “higher risk” if some element of your immune system isn’t working properly. This is also known as being “immunocompromised,” and it applies to the 50 million Americans (20% of the U.S. population) who are currently living with an autoimmune condition. 

Being immunocompromised means you are more likely to: 

  • Get infections frequently
  • Get more serious or rare consequences from infections
  • Stay infected for longer

With autoimmune diseases, your immune system mistakenly attacks your body’s own tissues and organs. Just having one of these diseases on its own can make you more susceptible to infection, including viruses. However, you are often at even higher risk because the many medications commonly used to treat autoimmune conditions act as immunomodulators — they change the way your immune system responds to potential threats.

Some of these medications weaken parts of your immune system in order to prevent it from attacking your own body. However, by doing so they may also make it easier for you to contract infections and viruses. Your risk of infection increases with your medication dose and the length of time you take it. 

The form you take the medication in can also be a factor. For example, if the medication is a cream or suppository, it has a more limited and local effect on your body, and so the risk of infection is only slightly increased. However, if you take these medications orally or through an injection, their effects spread throughout the body and therefore lead to a higher risk of infection. 

Below, we’ve broken down some common autoimmune conditions and the immunomodulating drugs used to treat them. We’ve covered ten common immune-related conditions: psoriasis, alopecia areata, ankylosing spondylitis, ulcerative colitis/Crohn’s disease, rheumatoid arthritis, lupus, multiple sclerosis, Graves’ disease, hidradenitis suppurativa, and uveitis. If any of the below information applies to you, you may benefit from taking extra precautions to avoid contracting COVID-19. 

Lastly, we listed some suggestions for strengthening your immune system as well. 

Psoriasis

Psoriasis is an autoimmune disease that primarily affects the skin, resulting in itchy, scaly, red patches. Currently, approximately 8 million Americans live with psoriasis. 

While this chronic condition has no cure, psoriasis symptoms can be managed and put into remission with a variety of medications. The mildest cases of psoriasis may be managed using skin moisturizers and other lifestyle changes like using special soaps to protect their skin. Depending on how much of the body is affected and the severity of the psoriasis, medical treatments start with topical corticosteroids and/or methotrexate. Patients may also receive phototherapy, in which ultraviolet light is used to slow the progression of psoriasis. If the psoriasis isn’t adequately managed by those therapies, patients may be prescribed oral corticosteroids, immunosuppressants, biologic agents, and other treatments.

Because topical options such as creams or gels target a local area rather than the whole body, they do not put you at as great a risk of infection as oral or injected forms of these medications. 

Some of the medications for psoriasis that may increase your risk of infection include:

  • Steroids
  • Acitretin (Soriatane)
  • Methotrexate (Rheumatrex)
  • Apremilast (Otezla)
  • Cyclosporine (Sandimmune, Neoral)
  • Thioguanine (Tabloid)
  • Hydroxyurea (Droxia, Hydrea)
  • Adalimumab (Humira)
  • Brodalumab (Siliq)
  • Certolizumab (Cimzia)
  • Etanercept (Enbrel)
  • Guselkumab (Tremfya)
  • Infliximab (Remicade)
  • Ixekizumab (Taltz)
  • Secukinumab (Cosentyx)
  • Tildrakizumab (Ilumya)
  • Ustekinumab (Stelara)

Those with psoriasis may further develop psoriatic arthritis. This condition is characterized by swelling of fingers and toes, along with pitting or thickening of finger- and toenails. 

Some medications are effective for treating symptoms of psoriatic arthritis even though they are not typically used for psoriasis. These include some drugs that affect your immune system:

  • Abatacept (Orencia)
  • Azathioprine (Azasan, Imuran)
  • Golimumab (Simponi)
  • Leflunomide (Arava)
  • Sulfasalazine (Azulfidine)
  • Tofacitinib (Xeljanz)

Alopecia Areata

With alopecia areata, your immune system attacks your hair follicles, resulting in hair loss. About 6.8 million Americans are affected by alopecia areata. 

This condition is typically managed by local treatments like creams or small injections of corticosteroids. For more severe cases, oral steroids or immunotherapies may be used. However, there is only limited research on the use of systemic immunotherapies for alopecia.

Some of the medications for alopecia areata that may increase your risk of infection include: 

  • Steroids
  • Cyclosporine (Sandimmune, Neoral, Gengraf)
  • Diphenylcyclopropenone (also known as diphencyprone)
  • Ruxolitinib (Jakafi)

Ankylosing spondylitis

This autoimmune and inflammatory condition is a type of inflammatory arthritis that affects the small joints and vertebrae along your spine, causing them to fuse together. Around 2.7 million Americans are believed to be living with ankylosing spondylitis currently. 

Immune-modulating medications are used to reduce the inflammation, pain, and stiffness associated with the disease. These primarily include disease-modifying anti-rheumatic drugs (DMARDs) and biologic therapies: 

Some of the medications for ankylosing spondylitis that may increase your risk of infection include: 

  • Adalimumab (Humira)
  • Certolizumab pegol (Cimzia)
  • Etanercept (Enbrel)
  • Golimumab (Simponi)
  • Infliximab (Remicade)
  • Secukinumab (Cosentyx)
  • Ixekizumab (Taltz)

Ulcerative Colitis/Crohn’s Disease

Ulcerative colitis and Crohn’s disease are two forms of inflammatory bowel disease (IBD), an autoimmune condition where your body attacks your digestive tract. Around 1.6 million Americans are currently living with IBD. 

Treatment for mild or moderate forms of these conditions typically consists of the immunomodulators methotrexate and thiopurines. These may be combined with corticosteroids to manage some of the symptoms. If these are not enough to control the symptoms of IBD, biologic agents and/or surgeries may be required.

Some of the medications for  IBD that might increase your risk of infection include: 

  • Steroids
  • Methotrexate (Rheumatrex)
  • Sulfasalazine (Sulfasalazine)
  • Mesalamine (Asacol, Delzicol)
  • Olsalazine (Dipentum)
  • Balsalazide (Colazal)
  • Azathioprine (Azasan, Imuran)
  • Mercaptopurine (Purinethol, Purixan)
  • Cyclosporine (Sandimmune, Neoral, Gengraf)
  • Tacrolimus (Envarsus, Protopic, Astagraf)
  • Adalimumab (Humira)
  • Certolizumab pegol (Cimzia)
  • Infliximab (Remicade)
  • Natalizumab (Tysabri)
  • Ustekinumab (Stelara)
  • Vedolizumab (Entyvio)

Graves’ disease

Graves’ disease is an autoimmune condition where your immune system triggers the overproduction of thyroid hormones, causing hyperthyroidism. It affects approximately 1.6 million Americans

This condition is generally treated with radioactive iodine therapy, anti-thyroid medications, and beta-blockers. Immune-modulating treatments are also used to treat Graves’ ophthalmopathy, a consequence that causes eye inflammation. 

Some of the medications for Graves’ disease that may increase your risk for infection include:

  • Propylthiouracil (Propacil)
  • Methimazole (Tapazole)
  • Prednisone (Deltasone)

Rheumatoid Arthritis

Rheumatoid arthritis (RA) is an autoimmune disease that affects about 1.5 million Americans. If you have RA, your immune system mistakenly attacks your own body tissue. Often, it is the lining of your joints that are most impacted, although in some people the disease also affects other parts of the body (such as your skin, eyes, lungs, heart, and/or kidneys). 

There are a wide variety of immunosuppressants commonly prescribed to treat RA, including Janus kinase (JAK) inhibitors, nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, tumor necrosis factor (TNF) inhibitors, calcineurin inhibitors, and inosine monophosphate dehydrogenase (IMDH) inhibitors. 

Some of the medications for RA that may increase your risk of infection include:  

  • Steroids
  • Methotrexate (Rheumatrex)
  • Leflunomide (Arava)
  • Hydroxychloroquine (Plaquenil)
  • Sulfasalazine (Azulfidine)
  • Tofacitinib (Xeljanz)
  • Baricitinib (Olumiant)
  • Upadacitinib (Rinvoq)
  • Etanercept (Enbrel)
  • Infliximab (Remicade)
  • Adalimumab (Humira)
  • Certolizumab pegol (Cimzia)
  • Golimumab (Simponi)
  • Tocilizumab (Actemra)
  • Sarilumab (Kevzara)
  • Cyclosporine (Gengraf, Neoral, Sandimmune)
  • Azathioprine (Azasan, Imuran)

Lupus

As with other autoimmune conditions, lupus involves your immune system attacking your tissues and organs. This can affect your joints, skin, kidneys, blood cells, brain, heart, lungs, and other areas. Around 1.5 million Americans currently have lupus. 

Treatment for lupus typically begins with the immunomodulator hydroxychloroquine. Corticosteroids may be used to mediate some symptoms, but ideally only for a short period of time. Depending on how well the symptoms are managed by those options, other immunomodulators or biologic therapies may be added.

Some of the medications for lupus that may increase your  risk of infection include:

  • Steroids
  • Hydroxychloroquine (Plaquenil)
  • Cyclophosphamide (Cytoxan)
  • Mycophenolate mofetil (CellCept)
  • Azathioprine (Imuram, Azasan)
  • Methotrexate (Rheumatrex)
  • Belimumab (Benlysta)

Multiple sclerosis

With this autoimmune disease, your immune system attacks the protective layer around your nerve fibers, affecting your brain and spinal cord. It can interfere with your brain’s ability to communicate with the rest of your body and lead to nerve damage. Multiple sclerosis (MS) affects approximately 1 million American adults. 

Therapies used for multiple sclerosis are referred to as “disease-modifying therapies” or DMTs. This is because the treatments are intended to prevent relapses and progression of the disease; options are very limited when it comes to treating the symptoms of MS. Patients are initially treated with immunosuppressants, and those with more active MS may be treated with biologic agents instead.

Some of the medications for MSthat may increase your risk of infection include :

  • Steroids
  • Teriflunomide (Aubagio)
  • Cyclophosphamide (Cytoxan, Neosar)
  • Fingolimod (Gilenya)
  • Dimethyl fumarate (Tecfidera)
  • Siponimod (Mayzent) 
  • Alemtuzumab (Lemtrada)
  • Natalizumab (Tysabri)
  • Ocrelizumab (Ocrevus)
  • Mitoxantrone (Novantrone)

Hidradenitis suppurativa

Hidradenitis suppurativa is a chronic inflammatory condition often associated with autoimmune conditions like ulcerative colitis and Crohn’s disease. Whereas autoimmune conditions involve the immune system launching an attack against specific tissues in the body, this condition involves your non-specific “innate immune system.” When this part of your immune system flares up in cases of hidradenitis suppurativa, painful lumps form under the skin. Around 328,000 patients in the U.S. are estimated to have hidradenitis suppurativa. 

This condition is treated with a range of medications, from topical creams to antibiotics to immune-modulating medications, depending on the severity of the disease. 

Some of the medications for hidradenitis suppurativa that may increase your risk of infection include: 

  • Cyclosporine (Sandimmune, Neoral, Gengraf)
  • Acitretin (Soriatane)
  • Isotretinoin (Zenatane, Absorica, Claravis)
  • Adalimumab (Humira)
  • Infliximab (Remicade)
  • Anakinra (Kineret)
  • Ustekinumab (Stelara)

Uveitis

Uveitis can be either infectious or non-infectious. If it’s infectious, the condition may be treated much like other infections—by activating the immune system against the pathogen. Non-infectious uveitis is an autoimmune condition that specifically causes inflammation of the eye, resulting in eye pain, worsened vision, and light sensitivity. It affects approximately 109,000 people in the U.S. 

Immune-modulating medications are used to treat autoimmune uveitis most often when it affects both eyes or your condition does not respond to milder forms of treatment. Initial treatment consists of corticosteroid eye drops and may progress to oral steroids and immunomodulators, including biologic therapies.

Some of the medications for uveitis that may increase your risk of infection include:

  • Steroids
  • Azathioprine (Azasan, Imuran)
  • Cyclosporine (Sandimmune, Neoral, Gengraf)
  • Methotrexate (Rheumatrex)
  • Mycophenolate (CellCept)
  • Abatacept (Orencia)
  • Adalimumab (Humira)
  • Infliximab (Remicade)
  • Rituximab (Rituxan)

What about natural ways of strengthening the immune system? 

While these medications might increase your risk of contracting COVID-19 or other infections, that doesn’t mean you should stop taking them. As with any drug, it requires a calculation of whether the benefits outweigh the risks. If you are concerned about your risk of infection during the current coronavirus pandemic, speak with your doctor and/or pharmacist. Do not stop taking your medication or change your drug routine without first consulting them. 

There are some steps you can take to improve your body’s ability to fight off infections, even if you are immunodeficient due to the above conditions and immune-modulating medications. Some lifestyle suggestions include:

  • Exercising regularly
  • Getting enough sleep (we put together a comprehensive guide to better sleep you can read as well for tips and suggestions)
  • Eating an antioxidant and vitamin-rich diet, including fruits, veggies, nuts, seeds, legumes, olive oil, and salmon
  • Washing your hands frequently and thoroughly
  • Reducing stress as much as possible

Unfortunately, these suggestions are not guaranteed solutions for a stronger immune system. However, the health benefits of these lifestyle changes will help support your immune system throughout the novel coronavirus pandemic and into the future. 

Dr. Jessica Nouhavandi

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