COVID-19 FAQs: Medications, Treatment and Vaccines

UPDATED: 8/21/2020

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

A: Twenty-seven coronavirus vaccines are in human trial stage as of July 30, 2020. Vaccines typically require years of research and testing before reaching the clinic, but scientists are racing to produce a safe and effective vaccine by next year.

Moderna, is the first American company to put a vaccine into human trials and hopes to have doses ready by early 2021. This vaccine is live, meaning it uses genetic material (mRNA) from the virus to trigger the immune system to fight the virus. In a study of 45 people published in the New England Journal of Medicine, the vaccine appeared to be safe. The participants were healthy adults, ages 18 to 55, who received two vaccinations 28 days apart and developed antibodies after the second short. More than half of the participants had side effects including injection site pain, fatigue, chills, muscle aches and headaches but they were not considered serious.

Another vaccine by the British-Swedish company AstraZeneca and the University of Oxford is in development. In their Phase I/II trials, the vaccine was reported to be safe, without severe side effects and raised antibodies against the coronavirus. The vaccine is now in Phase II/III clinical trials in England, as well as Phase III trials in Brazil and South Africa. If approved, AstraZeneca has said their total manufacturing capacity for the vaccine stands at two billion doses.