Do patients with chronic inflammatory diseases have a higher risk for severe infection by COVID-19 due to their medications?

Bottom Line:

While there is limited evidence to date, the analysis of inflammatory signalling proteins suggests that most cytokine inhibitors used in treatment of diseases like psoriasis, atopic dermatitis, and inflammatory bowel disease, do not automatically increase the risk of severe COVID-19 infection.

Reference:

Schett, G. et al. COVID-19: risk for cytokine targeting in chronic inflammatory diseases? Nature Reviews Immunology (2020). https://doi.org/10.1038/s41577-020-0312-7

Date Published:

15 April 2020

Synopsis:

Patients with chronic inflammatory diseases such as psoriasis, atopic dermatitis, and inflammatory bowel disease are characterized by immune dysfunction. Regardless of the condition, most involve cells from the innate (non-specific) immune system such as granulocytes and macrophages. Many of these disorders have been treated in the past with cytokine inhibitors, a group of medications that reduce the production or function of cytokines (inflammatory signaling proteins). Coronavirus disease 2019 (COVID-19) activates innate immune cells and cytokines, especially in patients with severe disease. Even though many of the cytokines in COVID-19 are important for mounting inflammation, they do not seem to affect clearance of the virus which depends on other cytokines such as IL-15, type I interferons, interferon-gamma. Therefore, most recommendations from specialists such as dermatologists, rheumatologists and gastroenterologists do not support pre-emptively stopping anti-cytokine therapy if there are no signs of COVID-19 infection. Some cytokine inhibitors such as hydroxychloroquine are in fact and are currently being tested for treatment of COVID-19, with presumed role in reducing the hyperinflammatory state that is caused in severe COVID-19. Future trials will help us better understand the effect of COVID-19 in patients with inflammatory and autoimmune conditions.

Summary by: Sheida Naderi-Azad