COVID-19 and People with Lupus: Risk is Uncertain, and Recommendations are Evolving
In a recently published letter, lupus experts discuss the current facts, uncertainties and recommendations for people with lupus during the COVID-19 pandemic. Much remains unknown about the novel coronavirus and the risk it poses to different types of people. It is possible that people with lupus may be especially vulnerable to infection and more likely to develop severe complications.
There have not been many studies looking at respiratory complications of human coronaviruses in people with autoimmune diseases or those taking immunosuppressant drugs, but there have been case reports of other types of coronaviruses causing pneumonia in immunocompromised patients, suggesting people with lupus may be at greater risk. Additionally, lymphopenia, which is characterized by low levels of immune-supporting white blood cells and common among people with lupus, is associated with increased COVID-19 disease severity and mortality.
While the Centers for Disease Control and Prevention (CDC) recommends generally avoiding corticosteroids due to the medications’ possible role in promoting viral infections, the American College of Rheumatology suggests that people with lupus talk to their rheumatologist before stopping any medications. While people suspected of having the virus may benefit from corticosteroid medication changes, people with lupus without clear evidence of exposure should continue their regular treatment regimen.
Meanwhile, other COVID-19 treatments are being aggressively investigated. Remdesivir (an experimental antiviral drug) and chloroquine (an antimalarial drug frequently used to treat lupus), have demonstrated potential effectiveness in early trials, and further research is underway. The Food and Drug Administration has also approved of randomized controlled clinical trials of possible therapeutics for patients hospitalized with COVID-19. While the potential benefits of chloroquine and hydroxychloroquine (Plaquenil) remain unknown, medication compliance remains critically important for all patients with lupus.