COVID-19 FAQs: Medications and Treatments
Get the facts about medications and treatments for COVID-19, including how arthritis medications may impact infection risk and outcomes.
News, scientific understanding and guidelines about COVID-19 are continually evolving. As such, please note that some information on this page may have changed since its original publication date.
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.
However, a small study published in Annals of the Rheumatic Diseases in January suggests that patients with rheumatic disorders who receive biologics do have an increased risk for severe outcomes. Still, researchers note that more studies are needed to determine how just how large that risk is compared to the general population.
Additionally, 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: There is no cure for COVID-19, and only one treatment has been FDA-approved for COVID-19, the antiviral drug remdesivir. It was originally tested to treat Ebola and Hepatitis C. The drug may be used in patients ages 12 and older and weighing at least 88 pounds. Evidence suggests that it may modestly speed up recovery times. As of now, there is no specific information about how remdesivir impacts recovery for patients with autoimmune or inflammatory arthritis.
Doctors may try other medications off-label, or drugs approved for other uses, to treat COVID-19. The FDA has also issued emergency use authorization (EUA) for several treatments. EUAs are granted during public health emergencies and allow the use of unapproved drugs or unapproved uses of approved drugs when no other authorized option exists.
The latest treatment seeking EUA is molnupiravir, an antiviral pill from the drugmaker Merck. On October 1, the company said a key clinical trial showed that its pill cut the risk of hospitalization and death in half when given to high-risk patients with early-stage disease. If cleared, the drug, which was originally designed for the flu, would be the first pill to treat COVID-19. All other treatments require IV or injection.
Other commonly used treatments for COVID-19 include:
Monoclonal antibodies. Monoclonal antibodies are laboratory-made proteins that mimic the immune system’s ability to fight off viruses. They are given by infusion, which can last for hours. The FDA has granted EUA to a few monoclonal antibody treatments. In general, evidence suggests that monoclonal antibodies are most effective when given early in the infection. They may not help provide much help to patients already hospitalized with severe disease. Monoclonal antibodies can also lose effectiveness against new virus variants and mutations.
Convalescent plasma. After recovering from illness, the blood produces antibodies that help fight the virus. These antibodies are found in plasma, a component of blood. Using convalescent plasma — or plasma from recovered patients — isn’t new. It’s been used for more than 100 years to treat a variety of illnesses and is widely believed to be safe. The FDA granted convalescent plasma EUA to hospitalized patients who have early-stage disease and to people who cannot make their antibodies. However, studies about its effectiveness, especially among patients with severe COVID-19, are mixed.
Dexamethasone. The commonly used steroid has been shown to reduce deaths among critically ill patients on ventilators and receiving oxygen. However, it’s less likely to help, and may even harm, some patients with earlier-stage infections. In September 2021, researchers reviewed clinical trials of dexamethasone, along with two other steroids, hydrocortisone and methylprednisolone, and found that steroids were linked with a one-third reduction in deaths among Covid-19 patients.
The hype surrounding the effectiveness of the malaria drug hydroxychloroquine and the anti-parasitic drug ivermectin have been debunked. Studies show no benefits of using the drugs and health experts strongly advise against using them, citing serious potential health problems. The FDA warns that hydroxychloroquine can cause a host of serious side effects to the heart and other organs while saying that “[ivermectin] can cause serious harm in people.”
Ultimately, the decision to treat COVID-19 with any drug depends on the judgment of the physician and the health status of the patient. In general, doctors will proceed with caution if patients have poor liver or kidney function unless the potential benefits of using the drug outweigh the potential risks.
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 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.
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