COVID-19 FAQs: Medications, Treatment and Vaccines

UPDATED: 11/18/2020

Question: What’s the latest on COVID-19 vaccines?

A: Currently, there are 54 vaccines in human clinical trials and at least 87 preclinical vaccines being studied in animals. Twelve vaccines have reached the final stages of testing. So far, the two front runners are from Moderna and Pfizer/BioNtech.

Both vaccines use a genetic molecule called messenger RNA (mRNA), which teaches cells to create a version of the coronavirus spike protein. This prompts the immune system to make antibodies against this spike protein so the body can recognize the virus and fend off future infections. The technology is new, unlike traditional vaccines that use weakened live or dead versions of the entire virus, which take longer to produce. Likewise, these types of vaccines are expected to be as safe for immunocompromised patients and patients on immunosuppressant medications as for the general population.  

Early data suggests that the vaccines will be highly effective –Moderna’s vaccine is estimated to be 94.5% effective, whereas Pfizer/BioNtech’s is projected to be about 95% effective.

Moreover, early data from the Moderna trial suggests its vaccine doesn’t just block the virus in most cases, but also may prevent severe disease in those who do get sick.

How long immunity may last from the vaccines, which require two doses, is still under review. New research about natural immunity to the virus suggests that most people who get the virus may be protected for a few years (though more data is needed). If this proves to be true, this is likely good news for controlling the pandemic, as vaccines tend to produce stronger immune responses than natural infections.

There’s more work to be done before companies will know the true safety and efficacy of their vaccines, but early data is promising. Both companies are expected to apply for FDA emergency use authorization and to begin rolling out vaccines in December.

Still, even once the vaccines are FDA-approved, it will take months to reach widespread distribution. Those who are most vulnerable to infection and severe outcomes, such as healthcare workers, essential workers, elderly and immunocompromised patients, will likely be prioritized first to receive the vaccine.

Question: Will COVID-19 vaccines interact with DMARDs and biologics used for arthritis?

A: People with rheumatic diseases will not be able to get any of the live vaccines under development for the novel coronavirus. “However, we don’t expect that there will be any issue with non-live vaccines,” explains vaccine researcher William Chen, MD, Chief of the Adult Clinical Studies, Center for Vaccine Development and Global Health, University of Maryland​.

“There are 176 COVID vaccines in development worldwide as of October 2020. Five of the seven vaccines that are most likely to be available in the United States in the next 12 months are non-live vaccines,” says Dr. Chen.

Question: Who determines vaccine allocation when one is available?

A: The Centers for Disease Control and Prevention (CDC) is developing policy statements related to national vaccine distribution. States will also be developing their guidelines that will likely mirror CDC guidelines as they determine how to allocate the vaccine to the highest risk population first. “The process has to be equitable, fair and transparent,” explains Dr. Chen​. “These discussions are happening within the government and policy groups that I’m a part of.” Dr. Chen outlines the breakdown of populations at risk as follows:

• Health care personnel, 20 million​
  • Hospitals, longer-term care facilities, outpatient, home health, pharmacies, EMS, public health​
• Essential workers, non-health care, 60 million​
  • Food and agriculture, transportation, education, energy, water and wastewater, law enforcement​
• Older Adults age 65 or older, 53 million​
• High Risk Medical Conditions, more than 100 million

Question: Am I at a higher risk for getting COVID-19 because I take immune-suppressing arthritis medications?

A:  There is limited data about the effects of immunosuppressant medications on infection risk. However, current evidence shows that people taking disease-modifying antirheumatic drugs (DMARDs), including biologics, are not at a higher risk for getting COVID-19. In fact, experts believe that well-controlled disease activity may help decrease the risk of infection, so in that regard, medication is beneficial.

Additionally, patients taking biologics, JAK inhibitors and conventional DMARDs, such as methotrexate, do not seem to have an increased risk of severe disease or hospitalization, according to findings presented at the virtual European League Against Rheumatism (EULAR) 2020 Congress.

There is one important exception: People taking corticosteroids (e.g. prednisone) at doses of 10 mg or higher have an increased risk of being hospitalized with any infection, including a COVID-19 infection. But do not stop taking corticosteroids (also called glucocorticoids) suddenly. Talk with your doctor about the risks and benefits of taking these medications. If the decision is to stop, work with your doctor to taper safely.

Question: Should I stop or reduce my arthritis drug even though I don’t have any coronavirus symptoms or a confirmed infection?

A:  The short answer is no. Stopping immunosuppressive medications puts you at a higher risk for disease flares, worsening symptoms and developing joint damage.

Recent research from the European League Against Rheumatism (EULAR) suggests that the majority of people with rheumatic diseases who contract COVID-19 have similar outcomes to the general population, regardless of which disease-modifying medication they take.

However, certain medications may need to be temporarily stopped if you have a confirmed infection, have been exposed to someone with a COVID-19 infection or are experiencing common COVID-19 symptoms such as fever, dry cough and shortness of breath. But experts warn patients not to stop or change medication dosage without calling their doctors. This is especially important with corticosteroids, which should never be stopped suddenly. The American College of Rheumatology has issued coronavirus medication guidelines for both adult and pediatric rheumatology patients.

If you have any symptoms of COVID-19 or have been exposed to the virus, contact your doctor immediately. Your doctor will help you decide the best course of action.

Question: Is there an approved treatment for COVID-19?

A: No. And don’t believe any internet hype claiming there are “cures” for COVID-19 either. There are no FDA-approved medicines indicated for the treatment or prevention of COVID-19. However, doctors may try other medications approved for other uses to treat the coronavirus.

Likewise, researchers are studying other drugs to treat the coronavirus, including the investigational anti-viral drug, remedisivir. In May, the Food and Drug Administration issued an emergency use authorization so that remdesivir could be used in adults and children hospitalized with severe disease. But this does not mean the drug has been proven effective for all cases. Clinical trial results using remdesivir to treat the coronavirus have been mixed; some show a modest improvement in recovery time while others show no benefit at all.

Ultimately, the decision to treat COVID-19 with any drug, including remdesivir, depends on the judgment of the physician and the health status of the patient. There is no information about how remdesivir affects patients with autoimmune or inflammatory arthritis. In general, patients who have poor liver or kidney function are not considered good candidates unless the potential benefits of using the drug outweigh potential risks.

Question: Some arthritis medications are being tested to treat COVID-19. Does that mean people who take these medications are protected against the virus?

A: Some disease-modifying antirheumatic drugs (DMARDs) and biologics are being tested as potential therapies for the virus. Testing is a complicated process and it is unknown whether a specific medication provides additional protection against SARS-CoV-2, the virus that causes COVID-19.

Additionally, some patients with COVID-19 experience a serious complication called a cytokine storm. A cytokine storm is a faulty immune response that causes the body to attack its own tissues and cells instead of the virus. Some disease-modifying anti-rheumatic drugs (DMARDs) and biologics used to treat inflammatory types of arthritis are being explored to treat this complication.

Until an FDA-approved treatment is widely available, rheumatologists believe that the most important way to minimize your risk is follow the recommended public health measures and keep your rheumatic disease under good control. If you are exposed to the virus or become symptomatic, contact your doctor right away.

Question: Should I continue to get my arthritis treatment at an infusion center?

A: Yes. Keeping your disease well-controlled and sticking with your medication regimen, including infusions, is essential to staying healthy during the pandemic. Failure to do so can cause disease flares, worsening symptoms and potential joint damage. However, if you have a COVID-19 infection or are showing symptoms of a possible infection, your doctor may decide to temporarily stop or reduce the dosage of certain medications. Always consult your doctor first before discontinuing any medication.   

If you’re uneasy about in-person appointments, call your doctor’s office ahead of time to ask about any new processes to enhance safety. Learn more about important safety measures for infusion appointments here.

Question: I heard taking NSAIDs can worsen the coronavirus. Should I stop taking NSAIDs in case I get sick?

A: There is no evidence that taking NSAIDs worsens the coronavirus or increases infection risk. Health experts recommend that people who need NSAIDs for pain relief or disease management continue to use them as directed. However, if you develop a COVID-19 infection, contact your doctor immediately for advice.

Question: Is it possible that there will be a shortage of biologics or DMARDs used for arthritis?

A: It’s unclear, but the FDA is actively monitoring the situation and is trying to stay ahead of any shortages or disruptions in the medical supply chain. You can find more information about medication access during the COVID-19 outbreak, including possible shortages or patient assistance programs, by clicking on the following links below:

Abbvie: (Humira), (RINVOQ)  https://www.abbvie.com/coronavirus.html
Amgen: (Enbrel)(Evenity) (Prolia)  https://www.amgen.com/covid-19/  
Bristol Myers Squibb: (Orencia) https://www.bms.com/about-us/responsibility/coronavirus-updates.html  
Genentech: (Actemra), (Rituxan) https://www.gene.com/covid19

GlaxoSmithKline: (Benlysta) ​​​​https://www.gsk.com/en-gb/media/resource-centre/our-contribution-to-the-fight-against-2019-ncov/  
Janssen/Johnson and Johnson: (Remicade), (Simponi) (Stelara) ​​http://www.jnj.com/coronavirus  
Eli Lilly: (Taltz) https://www.lilly.com/news/stories/coronavirus-covid19-global-response  

Merck: (Renflexis) https://www.merck.com/about/featured-stories/how-we-are-responding-to-the-global-pandemic-COVID-19.html  
Novartis: (Cosentyx) (Ilaris) https://www.novartis.com/news/coronavirus-disease-covid-19-update
Pfizer: (Celebrex), (Inflectra), (Lyrica), (Xeljanz)  https://www.pfizer.com/health/coronavirus  
Sanofi: (Kevzarra) https://www.sanofi.com/en/about-us/our-stories/sanofi-s-response-in-the-fight-against-covid-19 

Sobi: (Kineret) Call: 781.786.7370 
UCB: (Cimzia)  https://www.ucb.com  

Question: I take hydroxychloroquine (Plaquenil). What should I do if I can’t get a refill?

A:  Fortunately, there haven’t been recent reports of a hydroxychloroquine shortage, but here’s what you can do:  

• If you are due for a refill, don’t wait until the last minute to call your pharmacy.
• If your refill is for 30 days, ask your doctor for a 90-day supply to give you a cushion in case it’s difficult to find later.  
• If your pharmacy can’t fill a full 90-day prescription due to short supply, ask to be contacted as soon as additional stock comes in.  
• Be sure to tell your pharmacist the reason you are taking the medication. Some states give pharmacists the discretion to decide which prescriptions to prioritize, if stock is low.  

Question: Is the biologic that I take protective against COVID-19 since some biologics are being tested as COVID treatments?

A: There is no evidence yet in the studies completed so far that being on a biologic is protective against COVID. “We’re still in the early phases and the story may change over time, “explains Laura Lewandowski, MD, Clinical Fellow, Systemic Autoimmunity Branch, ​
National Institutes of Arthritis and Musculoskeletal Skin Diseases, National Institutes of Health​. “However, all of them are not being studied as protective measures. In one study so far, rheumatology patients do not seem to be at an increased risk for COVID illness or hospitalization, but it doesn’t seem as if they have any special protection.”

There have been small studies of hydroxychloroquine (Plaquenil) as a preventative medicine in areas with limited personal protective equipment for health care workers. It has not been shown to prevent virus transmission. So, it’s very important to wear a mask and be vigilant about hand hygiene.

Question: Who determines vaccine allocation when one is available?

A: The Centers for Disease Control and Prevention (CDC) is developing policy statements related to national vaccine distribution. States will also be developing their guidelines that will likely mirror CDC guidelines as they determine how to allocate the vaccine to the highest risk population first. “The process has to be equitable, fair and transparent,” explains Dr. Chen​. “These discussions are happening within the government and policy groups that I’m a part of.” Dr. Chen outlines the breakdown of populations at risk as follows:

• Health care personnel, 20 million​
  • Hospitals, longer-term care facilities, outpatient, home health, pharmacies, EMS, public health​
• Essential workers, non-health care, 60 million​
  • Food and agriculture, transportation, education, energy, water and wastewater, law enforcement​
• Older Adults age 65 or older, 53 million​
• High Risk Medical Conditions, more than 100 million