COVID-19 and immunosuppression: a review of current clinical experiences and implications for ophthalmology patients taking immunosuppressive drugs

Abstract

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in December 2019 in Wuhan city, Hubei province, China. This is the third and largest coronavirus outbreak since the new millennium after SARS in 2002 and Middle East respiratory syndrome (MERS) in 2012. Over 3 million people have been infected and the COVID-19 has caused more than 217 000 deaths. A concern exists regarding the vulnerability of patients who have been treated with immunosuppressive drugs prior or during this pandemic. Would they be more susceptible to infection by the SARS-CoV-2 and how would their clinical course be altered by their immunosuppressed state? This is a question the wider medical fraternity—including ophthalmologists, rheumatologists, gastroenterologist and transplant physicians among others—must answer. The evidence from the SARS and MERS outbreak offer some degree of confidence that immunosuppression is largely safe in the current COVID-19 pandemic. Preliminary clinical experiences based on case reports, small series and observational studies show the morbidity and mortality rates in immunosuppressed patients may not differ largely from the general population. Overwhelmingly, current best practice guidelines worldwide recommended the continuation of immunosuppression treatment in patients who require them except for perhaps high-dose corticosteroid therapy and in patients with associated risk factors for severe COVID-19 disease.

The duration of infectiousness of individuals infected with SARS-CoV-2

“… 40 , 41 However, some of these agents are also being investigated as treatments for severe and critical COVID-19 to modulate the hyperinflammatory response (e.g., tocilizumab). 42 , 43 Little is known regarding the presentation and course of disease in patients who are immunocompromised; it is unknown whether all patients who are in an immunocompromised state necessarily present with severe COVID-19 disease, or how important the degree of immunosuppression is for clearance of the virus. 43 More evidence is required to understand the relationship between immunosuppression and the illness severity and duration of infectiousness of SARS-CoV-2.…”

“… 42 , 43 Little is known regarding the presentation and course of disease in patients who are immunocompromised; it is unknown whether all patients who are in an immunocompromised state necessarily present with severe COVID-19 disease, or how important the degree of immunosuppression is for clearance of the virus. 43 More evidence is required to understand the relationship between immunosuppression and the illness severity and duration of infectiousness of SARS-CoV-2. However, in these individuals it is very likely that any molecular investigations would indicate a significant SARS-CoV-2 viral load.…”

Incidence of SARS‐CoV‐2 infection in inflammatory bowel disease

“…Furthermore, biologics, which are also associated with increased risk of viral infections, are primary treatment methods for controlling the disease in many inflammatory bowel disease (IBD) patients 2 . While evidence from the SARS and Middle East Respiratory Syndrome (MERS) outbreaks suggest that immunosuppression is unlikely to increase the individual's susceptibility to infection, 3 whether this holds true in the context of SARS‐CoV‐2 is uncertain.…”

<p>Clinical Characteristics and Outcomes Among COVID-19 Hospitalized Patients with Chronic Conditions: A Retrospective Single-Center Study</p>

“…They are more susceptible to infection by the COVID-19 and tend to develop more severe infections. 10 In Saudi Arabia, a single study was conducted to assess clinical characteristics of COVID-19 patients. 11 While the study provided a valuable look at the characteristics of COVID-19 patients in Saudi Arabia, it did not demonstrate the differences in clinical characteristics and the outcomes in terms of the number of chronic conditions.…”