What You Should Know About Taking Immunosuppressants and COVID-19

The high-risk population in regard to COVID-19 includes anyone over the age of 60, those with chronic conditions like heart or lung disease, and anyone who is immunocompromised in some way—such as individuals who take immunosuppressants. Here's everything you need to know about taking those medications in connection to COVID-19.

What Exactly Are Immunosuppressants, and How Are They Used?

Immunosuppressants "suppress" the immune system, which essentially means turning off or reducing the body's typical immune response. These drugs are commonly used after organ transplants so the body doesn't reject the new organ, and often play a role in cancer treatment. Immunosuppressants are also prescribed to treat a variety of autoimmune conditions.

The bodies of those with autoimmune conditions are attacked by their own immune systems, which can cause inflammation and tissue, organ, and joint damage, along with overgrowth of cells. Those conditions are varied and include diseases like rheumatoid arthritis, lupus, inflammatory bowel disease (IBD), and psoriasis, among others. In these situations, suppressing the immune system can reduce these symptoms for many people with autoimmune disorders.

There are several classes of immunosuppressants, with each type working in different ways for different conditions; some patients, particularly those pre- or post-organ transplant, may need to take multiple types.

• Inhibitors block specific enzymes or proteins that affect how the immune system works. Checkpoint inhibitors are used in cancer treatments, per the National Cancer Institute (NCI).
• Steroids, like prednisone, reduce the immune response caused by autoimmune conditions and may also be prescribed after organ transplants, according to the National Kidney Foundation.
• Monoclonal antibodies work in many different ways, one of which is by blocking immune system cells that prevent cancer-fighting ones from doing their job, the NCI says.
• Biologics are chemical proteins that target certain parts of the immune system, specifically the ones that trigger inflammation, according to the Arthritis Foundation.

Do Immunosuppressants Make You More Susceptible to COVID-19?

"Immunocompromised people have an underlying condition that reduces their actual ability to respond effectively to infections, while people on immunosuppressive drugs can become compromised as a result of the medication they're taking," explained rheumatologist Doug Roberts, MD, assistant clinical professor of medicine at the University of California Davis Medical School and medical advisor to CreakyJoints.

So, in either case, being immunocompromised or immunosuppressed affects your body's ability to defend itself from many pathogens. Taking immunosuppressants could put you at an elevated risk of getting COVID-19—depending on the severity of your health condition.

As of February 2022, the Centers for Disease Control and Prevention (CDC) identified those in an immunocompromised state to be more susceptible to critical sickness due to COVID-19. It additionally noted an increased risk of severe effects from COVID-19 among people who are moderately or severely immunocompromised. In other words, some immunocompromised individuals will be more at risk for COVID-19 than others.

"There are so many different kinds of immunomodulatory, and where you are on the spectrum changes based on which medications you're on, [how old you are, and the severity of your symptoms]," said Dr. Roberts.

What Steps Can You Take To Protect Yourself Further?

If you're immunocompromised, being told to wash your hands, stay away from sick people, and disinfect regularly-used items like cell phones is nothing new, said Judith Lytle, MD, a general practitioner associated with Boston Medical Center. "I think many patients on immunosuppressants are probably already well-versed and doing the hand washing that is important for everyone," said Dr. Lytle.

It is also important to continue practicing other CDC guidelines like wearing masks, taking precautions if you have to travel, and getting vaccinated. As of April 2022, the CDC has provided vaccination information for people who are immunocompromised at moderate and severe levels, aged 5 and older.

Dr. Lytle added that if everyone got on board with some basic protective measures, it would go a long way toward helping immunocompromised or immunosuppressed people. "It's the people who are healthy—and serving as vectors for this virus, passing it to those less healthy—that need to be every bit as diligent."

You also want to ensure you're as healthy as possible. That means making sure any underlying conditions are identified and well-controlled. Additionally, practicing healthy habits like eating right, getting enough sleep, and exercising—as long you feel well enough—can help boost your immune system.

Should You Pause Your Treatment During COVID-19?

Individuals who fall under the category of being immunocompromised are typically given strict instructions on how to protect and support their immune systems when it comes to COVID-19. For example, a January 2021 study from Therapeutic Advances in Drug Safety indicated that individuals taking immunosuppressants were, across the literature, instructed against sudden discontinuation of their medication if they had not been infected with COVID-19.

Some medical professionals, like Dr. Roberts, have suggested talking with your physician about pausing or reducing your treatment depending on your medical history and condition. "I've seen many of my patients for 10 to 20 years, so I'm making individual recommendations based on what I know about their history," said Dr. Roberts.

If you're on a medication that's controlling a more severe underlying autoimmune disease, however, pausing medication is not a good idea, said Dr. Lytle. "I think most people are getting more benefit from the medication than they will be stopping the medication to prevent coronavirus," added Dr. Lytle. "Plus, if you have an underlying autoimmune disease—like inflammatory colitis, for example—you're at a higher risk of getting sick if your symptoms return, and if you're well-controlled right now on your drugs, it's hard to get back on them later with the same clinical benefit."

Ultimately, deciding whether or not to pause or reduce your immunosuppressive treatment is highly individual. Making that decision should be taken under consideration with your doctor and not done on your own. If you're worried, reach out to your provider and ask them to counsel you on the right choice for your health.

The information in this story is accurate as of press time. However, as the situation surrounding COVID-19 continues to evolve, it's possible that some data have changed since publication. While Health is trying to keep our stories as up-to-date as possible, we also encourage readers to stay informed on news and recommendations for their own communities by using the CDC, WHO, and their local public health department as resources.

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