Learn from researchers

When the immune system works correctly, it reacts to a pathogen with just the right level of response. If the immune system doesn’t work well enough, the pathogen wins and overcomes the body. But if it is too strong, the immune system sends out too many signals using chemical messengers called cytokines to fight the infection and causes too much inflammation that damages nearby organs.

Overactive immune responses are characteristic of people with lupus and other inflammatory rheumatic diseases as well as severe cases those infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). That is why many of the drugs used to treat lupus and other autoimmune diseases such as rheumatoid arthritis may help treat hospitalized patients who have developed serious COVID-19 in response to exposure to this specific coronavirus.

Anti-inflammatory Drugs that May be Repurposed for COVID-19

Tocilizumab (Actemera®). In anecdotal reports from China, the drug tocilizumab that blocks or inhibits the receptor of interleukin 6 (IL-6) that promotes inflammation has shown promise in treating serious COVID-19 patients with lung damage. An immunosuppressant, tocilizumab is approved by the U.S. Food and Drug Administration for moderate to severe rheumatoid arthritis and other inflammatory diseases. The pharmaceutical company Roche has launched a trial to see if tocilizumab could improve outcomes in pneumonia caused by COVID-19.

Sarilumab (Kezvara®). Another IL-6 inhibitor, sarilumab, is also being tested in a clinical trial for treating pneumonia caused by COVID-19. The trial is sponsored by its manufacturers Regeneron and Sanofi. Kezvara is approved by the U.S. Food and Drug Administration to treat moderate to severe rheumatoid arthritis after a disease-modifying agent was tried.

Chloroquine and Hydroxychloroquine. These antimalarial, anti-rheumatic drugs are commonly used as disease-modifying agents that lessen inflammation in lupus, rheumatoid arthritis and some skin diseases. Studies have found that chloroquine and the less toxic hydroxychloroquine (known by the brand name Plaquenil) disrupt the ability of the coronavirus to enter and reproduce in human cells. Numerous clinical trials are testing hydroxychloroquine among patients with severe COVID-19 in the hospital; so far results are inconclusive, and the FDA warns against widespread use.

Auranofin (Ridaura®). Approved by the FDA for rheumatoid arthritis, auranofin is also being looked at by researchers at Georgia State University as a treatment for the coronavirus. Another disease-modifying agent, auranofin seems to interfere with the ability of the virus to replicate – make copies of itself, so the virus cannot spread through the body. As in rheumatic diseases, auranofin decreases inflammation.

Baricitinib (Olumiant) is a Janus Kinase (JAK) inhibitor approved by the FDA to treat moderate to severe rheumatoid arthritis. It is being looked at as a potential treatment for COVID-19 because of its ability to lessen inflammation. There is no clinical data to date on the use of baricitinib in COVID-19, but Eli Lilly and Company launched a Phase 2 trial to test the effectiveness and safety of the drug as a treatment for hospitalized patients with COVID-19. The study is set to begin this month in the U.S. and expand to Europe and Asia; results are expected by mid-June.

What is COVID-19?

In December 2019, a new virus called SARS-COV-2 was identified in Wuhan, China. This virus was found to cause a severe respiratory illness in patients which was later named after the type of virus that caused it and the year it was identified (coronavirus disease 2019 or COVID-19).

Should people with lupus be especially concerned about COVID-19?

People with lupus are predisposed (at greater risk) to infections because of their disease as well as the medications they take to manage it. Click here for information from the U.S. Centers for Disease Control and Prevention (CDC), the American College of Rheumatology and other resources.

Are people with lupus immunocompromised?

People with lupus are considered immunocompromised and so could be at greater risk for infections in general because of their underlying disease itself and some of the medications they take to treat lupus. Click here for information from the CDC for people who are at risk.

Are people who are taking immunosuppressive medications more susceptible to infections such as COVID-19?

People taking immunosuppressive medications are considered to be immunocompromised and so could be at greater risk for infections in general. It’s best to consult with your healthcare professional for specific recommendations. You should not stop or alter your medications without consulting with your rheumatologist first. Not all people with lupus take immunosuppressive medications.

Currently, there is no specific data on the virus causing COVID-19 in patients with lupus. Thus, the rate and the severity of the infection in lupus patients is not yet known.

The CDC recommends that people at high risk:

• Stay home and avoid crowds as much as possible to further reduce your risk of being exposed. Also avoid non-essential travel.
• Have supplies on hand, including medications you normally take.
• When going out in public, keep away from others who are sick, wear a face mask, limit close social contact and wash hands often.

Are there treatments in development for COVID-19?

Several drugs are being studied to treat COVID-19.  One drug commonly used for lupus, hydroxychloroquine (Plaquenil) has had mixed results in preliminary studies and anecdotally as a potential treatment for COVID-19. Because of potential heart rhythm side effects, however, the U.S. Food and Drug Administration recommends limiting use of hydroxychloroquine to only COVID-19 patients in the hospital. Read More

A number of other drugs are being look at, including many commonly used to treat rheumatic diseases such as lupus and|or rheumatoid arthritis. Click here to learn more.  

Are people with lupus that take Plaquenil protected from developing COVID-19?

There is no research data that demonstrates that taking Plaquenil will protect a person from developing COVID-19.

All patients should follow the guidelines from their health care provider.  It is not recommended to make any changes to their treatment plan without first speaking to their provider.

What should I do if I can’t fill my prescription for Plaquenil?

The supply of Plaquenil seems to be increasing in many areas, so shortages do not seem to be posing as much of a problem as it was earlier on.  Meanwhile, in consulting with top lupus physicians and reviewing the scientific literature, the LRA wants to reassure people with lupus that for a short period of time not taking Plaquenil or taking a lower dose is concerning but not cause for alarm. Our scientific advisors recommend talking with your physician about the situation and possible alternatives.

How can I find out what my state is doing about access to Plaquenil?

The National Alliance of State Pharmacy Associations has been compiling a list of state actions affecting Hydroxychloroquine, Chloroquine, and Azithromycin. Click here for more information.

Why are drugs for lupus and rheumatoid arthritis being considered for COVID-19?

Overactive immune responses are characteristic of people with lupus and other inflammatory rheumatic diseases as well as severe cases of those infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). That is why many of the drugs used to treat lupus and other autoimmune diseases such as rheumatoid arthritis may help treat hospitalized patients who have developed serious COVID-19 in response to exposure to this specific coronavirus.

• Asymptomatic – producing or showing no symptoms
• Community spread – means people have been infected with the same pathogen in a specific geographic area, including some who are not sure how or where they became infected.
• Coronavirus – a family of viruses that can cause illness ranging from the common cold to more severe diseases such as Middle East Respiratory Syndrome (MERS) and Severe Acute Respiratory Syndrome (SARS).
• COVID-19 – abbreviation of “Coronavirus disease 2019”, a disease caused by a new coronavirus identified in 2019 called SARS-COV-2. In COVID-19, ‘CO’ stands for ‘corona,’ ‘VI’ for ‘virus,’ and ‘D’ for disease.
• Cytokine – small signaling proteins which are secreted by certain cells of the immune system and have an effect on other cells. (Examples: interferon, interleukin, and growth factors)
• Cytokine Storm – a severe immune reaction in which the body releases many cytokines into the blood too quickly, causing inflammation and damage to organs.
• Inflammation – a response that occurs when tissues are injured. The damaged tissues release chemicals that cause blood vessels to leak fluid into the tissues, causing swelling and heat.
• Immunopathology – unintended damage to body tissues caused by an immune response to an infection.
• Interleukin – a cytokine or signaling protein produced by immune cells for regulating immune responses.
• Prophylactic – intended to prevent disease.
• SARS-COV-2 – an abbreviation for “severe acute respiratory syndrome-coronavirus-2”. A virus identified in 2019 that causes a respiratory illness called COVID-19

Sources: U.S. Centers for Disease Control, National Institutes of Health, World Health Organization, Oxford Dictionaries