16 Apr COVID-19 Clinical Guidance for Patients with Rheumatic Diseases
MedicalResearch.com Interview with:
Ellen M. Gravallese M.D.
President, American College of Rheumatology
Dr. Gravallese discusses the recent guidance document issued by ACR for the treatment of rheumatic disease patients during the COVID-19 pandemic.
MedicalResearch.com: What is the background for this announcement? Are patients with rheumatic disease at greater risk of severe illness or death from the SARS-CoV-2 virus?
Response: This week the ACR issued a guidance document that is the product of the ACR’s Clinical Guidance Task Force, a newly appointed task force that includes experts in infectious disease, as well as experts in biologic and non-biologic rheumatic disease therapies. This clinical guidance document was prepared to assist rheumatology professionals in the care of their patients during this novel pandemic, and to advise as to how to handle rheumatic disease therapies. There is no data to suggest that patients with rheumatic disease are at greater risk of severe illness or death simply because they have a rheumatic disease. Rheumatic disease patients appear to be at risk for poor outcomes if they become infected primarily because of general risk factors such as older age or comorbid medical conditions, such as significant heart or lung disease. A global alliance has been created by the rheumatology community that has developed an international case-reporting registry to collect information pertinent to COVID-19 infection in patients with rheumatic disease. The ACR has played an active role in helping the Alliance get their message out to the rheumatology community, and we continue to support the Alliance with its data dissemination and communication efforts. We hope this registry will provide valuable data to address additional questions about the best way to manage rheumatology patients affected by COVID-19 and we encourage providers to submit their COVID-19-related cases to the Alliance website at www.rheum-covid.org.
MedicalResearch.com: Should patients with or without exposure to COVID-19 change their immunosuppressive regimen during this period?
Response: : In summary, in patients with rheumatic disease who are stable in the absence of COVID-19 infection, most rheumatic disease therapies may be continued. In patients who contract COVID-19 infection, the recommendations are that anti-malarial drugs (hydroxychloroquine and chloroquine) can be continued, but most other therapies should be stopped or held. The task force did single out anti-IL-6 agents and recommended a shared decision-making process with the patient and providers, especially in the hospital setting, regarding whether these agents should be stopped or held. Further details of recommendations for specific clinical scenarios can be found in the Clinical Guidance document on the ACR website.
MedicalResearch.com: Are any of the newer COVID-19 experimental treatments of particular risk or benefit to patients with rheumatic disease?
Response: Antimalarial drugs are currently being used in COVID-19 infection, and these are medications that are routinely used in the care of patients with systemic lupus erythematosus and other rheumatic diseases. The doses used for COVID-19, however, are typically higher than what would be used on a regular basis in the rheumatic diseases, and at higher doses, and/or in the setting of other drugs used for COVID-19, such as certain antibiotics, there is a reported risk of cardiac arrythmia.
MedicalResearch.com: Anything else to add or any disclosures?
Response: No disclosures.
Based on the evidence available to date, we recommend that patients with rheumatic diseases follow all general COVID-19 preventive measures, but in addition, rheumatology patients and providers may need to discuss ways to reduce the number of healthcare encounters and potential exposure to the virus that causes COVID-19 through measures such as monitoring blood work less frequently, using telehealth, and increasing the time between doses of intravenous medications. Patients and rheumatologists should work together to determine what approaches are best depending on their unique health and risk profiles.
COVID-19 Clinical Guidance for Adult Patients with Rheumatic Diseases Developed by the ACR COVID-19 Clinical Guidance Task Force This draft summary was approved by the ACR Board of Directors on April 11, 2020. A full manuscript is pending journal peer review
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