Coronavirus and biologics: Some good news?

The current coronavirus pandemic is concerning, but it can be especially so for people who take immunosuppressant biologics, including TNF and IL-17 inhibitors. Medications like Humira, Enbrel, and Cosentyx are known to suppress the immune system—after all, that’s how they stop autoimmune disease. Does taking these medications put someone more at risk for coronavirus? There’s a lot of information out there, and nothing is conclusive, but I’m going to share what I’ve seen. Some of it has even reassured me!

For an updated report from 5/2/20, see COVID-19 and immunosuppressants: new data. It provides data on biologics, oral steroids, methotrexate, and Plaquenil. For current research on Plaquenil, see We don’t know if hydroxychloroquine is safe for COVID.

First of all, I am not a doctor. The information that I’ve seen is scattered all over, so I just thought I’d put it in one place. If you have symptoms of coronavirus or concerns about your medication, contact your doctor immediately.

(Here, I use coronavirus to generally mean COVID-19.)

First, caution is best

Especially if you fall into high-risk categories—the elderly and those with conditions such as high blood pressure, lung disease, or diabetes—you should talk to your doctor about stopping your biologic medication. If you have signs of a respiratory infection, you should immediately talk to your doctor about stopping your biologic medication.

Not everyone should go off their biologics, though. My own doctor advised me not to. Others have even had their doctors say that stopping their biologics could cause a flare, which could increase their susceptibility to coronavirus. This is because high disease activity can cause immune dysregulation, which increases risk for infection. This isn’t specific to arthritis, either: those facing inflamatory bowel disease can also face additional complications from stopping their medications, for example.

Biologics don’t all work the same

It’s important to know that different biologics have different infectious risks. TNF inhibitors (Humira, Enbrel, Cimzia, Simponi, Remicade) increase risks for mycobacterial infections like tuberculosis. It’s why you always have to get a TB test before starting them. IL-17 inhibitors (Cosentyx, Taltz) increase risks for fungal infections like candida. Janus kinase inhibitors (Xeljanz) increase risks for shingles infections. This has to do with the different ways these medications work in the body, as they inhibit different parts of the immune response.

What does this mean for coronavirus? There isn’t data right now, but this shows that not all biologics increase your risk for all infections.

Biologics may actually be helpful for coronavirus

A self-identified doctor on Reddit explains how immunosuppressant biologics could even be used to combat complications of coronavirus. The most destructive part of severe coronaviruses (SARS, MERS, and now, COVID-19) is the body’s own immune response. Basically, the immune system goes haywire trying to destroy the virus and ends up destroying the body instead. What’s damaging people’s lungs isn’t coronavirus; it’s people’s own immune systems.

In the most severe cases, something called a “cytokine storm” happens, where the body releases excessive amounts of inflammatory proteins called cytokines. This causes damage to the lungs that can be permanent. One of the proteins that’s released is TNF-alpha. Can you see where this is going? In patients with the most severe cases, TNF inhibitors may actually help protect them from cytokine storm and further damage. IL-17 inhibitors (Cosentyx, Taltz) have also been proposed as possible treatments. Unfortunately, this is all speculation and hasn’t been tested yet.

The original Reddit post by MikeGinnyMD is worth a read if you want to know more in-depth info, including some information about steroid (prednisone) use. (Update: Recent data suggests that oral steroid use is more harmful than first reported.)

A list for further reading

The information I used to write this has been pulled from the following sources:

• Spondylitis Association of America, Coronavirus and Spondyloarthritis
• Arthritis Foundation, Coronavirus and Arthritis
• Crohn’s and Colitis Foundation, IBD Patient Guidelines
• Reddit, Let’s talk about what (little) we know about TNF inhibitors and COVID-19
• Reddit, What has your rheumatologist told you about COVID-19?
• Current Medical Research and Opinion, TNF-α inhibition for potential therapeutic modulation of SARS coronavirus infection
• The Lancet, Reducing mortality from 2019-nCoV: host-directed therapies should be an option
• Vox, How doctors can potentially significantly reduce the number of deaths from Covid-19
• The Arthritis Foundation’s LiveYes Online Community is hosting a forum specifically to get your answers about coronavirus answered by a medical expert.

For my most recent article about coronavirus, biologics, oral steroids, and methotrexate, check out COVID-19 and Immunosuppressants: New Data. For current research on Plaquenil, check out We Don’t Know if Hydroxychloroquine is Safe for COVID.

Stay safe and healthy, friends.

-Bri

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