Rheumatologists are familiar with the everyday use of immunomodulatory drugs. These are designed to treat the inflammation caused by autoimmune diseases such as rheumatoid arthritis. A EULAR taskforce was set up to develop a set of new points to consider to give guidance and advice on the best way to use these medicines to treat COVID-19. The taskforce included rheumatologists, immunologists, haematologists, paediatricians, patients and other health professionals. They looked at the published evidence on the use of immunomodulatory therapies to treat severe COVID-19.
In total, there are two overarching principles and 14 points to consider. The principles stress that the picture of SARS-CoV-2 infection can be very different in different people. Infections range from asymptomatic or mild disease to severe or fatal. People with COVID-19 may need different treatment approaches, including antiviral medicines, oxygen therapy, anticoagulation and/or immunomodulatory treatment at different stages of the disease. The 14 points to consider are split into two categories: pathophysiology, and immunomodulatory therapy. Pathophysiology is about the disease itself. Immunomodulatory therapy is about how we might use existing medicines from the field of rheumatology to treat severe COVID-19. These give specific advice about which treatments to use at what stages of the disease. The picture is changing very quickly, which means there are some areas of uncertainty. EULAR intends to update the advice in response to increasing knowledge and evidence both about the disease, and the impact of COVID-19 vaccines.
These findings do not apply to people living with RMDs who are taking immunomodulatory treatments for their rheumatic disease. Separate recommendations are available for the management of people with RMDs in the context of the pandemic.
Annals of the Rheumatic Diseases