Coronavirus (Covid-19) and Immunosuppressive medication (Imuran)

I also postponed an upcoming trip however my GI mentioned that when I do travel, simply use a mask, the n95 one both at the airport and most of all on the flight.

There is an upcoming concert where I am also and seeing as its indoors I may end up skipping it to be honest.

If it's of help to anyone, this is one way you can think about the situation: while it's true there are some aspects that make Covid-19 riskier than influenza, some of the largest risks have to do with your environment/community. When journalism sources show supplies being stockpiled, or schools being closed, one might start to wonder about things like mortality rate. The reason doctors are concerned, however, has a lot more to do medical services being overloaded. Even if you're taking immuno supressants/modulators for your condition, and even if you do get ill, it's overwhelmingly likely you'll recover fine. And even if you end up needing medical intervention, it's not like people don't get pneumonia already. We just want to make sure there's enough medical staff to go around. So the more that people isolate, the better.

infotrad said...
I find it disheartening that no one on this forum seems to give any relevant responses, i.e., address the specific case of persons on immunosuppressive medication with regard to this particular virus. I would look somewhere else for more pertinent info. I, myself, have found any yet on the Web. Why not ask the doctor who prescribed you the Imuran? I plan to so this.

I'm pretty certain I gave some relevant responses including what my gi doctor advised during my appointment last week

Sorry, I was not being clear. I was not thinking about precautions to avoid being infected but rather how people who take immunosuppressive medications would react to the virus vs people who to not take such medication (Imuran, Remicade, etc.) would be affected by the virus once the virus has gotten into into their system, i.e., is their immune system more vulnerable to the virus once infected, should they cease taking their immunosuppressive medication in order to allow their body to more effectively fight the effects of the virus?

Okay. I will. Thanks

just looked at that link. No one with IBD should be taking Ibruprofen anyway as it can cause gut inflammation and yes, the advice I've seen for those on steroids is taper off if possible, but not if it risks a flare and there is nothing else available. It's interesting on Twitter that IBD docs were discussing that general doctors are really behind the updated treatment plans for IBD that try to limit steroid use.

This article has some recommendations, which include not stopping immune suppressants as dealing with a flare could be worse than fighting the virus while on them https://www.thelancet.com/journals/langas/article/piis2468-1253(20)30076-5/fulltext

I was on Immuran for the better part of 15 years and only recently switched to Enbrel, as my 300mg of Immuran for 15 years was putting me at high risk of certain blood cancers.

My doctor told me to keep on with my Enbrel injections, and actually -- as it turns out, China is treating it's patients with immune suppressors that are typically used for people like us... those with autoimmune and arthritic diseases.

You can google this, so far they are having lifesaving results with Actemra, and they have also been experimenting with Remicaid, Humera, and several others. Actemra has actually been approved in China for fighting this virus.

As all of you know, most of us got our autoimmune diseases in the first place because we had something else -- some virus or bacterial infection that caused said storm and turned our own immune systems against us.

The cytokine storm created in severe reactions to the Covid 19 virus - basically causes the immune system of the body to hyperventilate and attack the lungs -- so the end result of this virus is much like what we all deal with - except in one giant gush that permanently damages or kills a person's lungs.

Ironic, that we who are all so sick and having to take immune suppressors and worrying about this, may actually, in this one case with this virus, be better off than the general population... very strange to think, but that's what it's starting to look like.

Let's just all be thankful that this isn't an outbreak of a new strain of TB....

It is a big unknown how imuran will impact us with this virus. That being said, it makes no sense to lower or stop the meds right now because it takes months to leave our bodies. My husband’s (former) stepfather is a GI at UCSD and he emailed me yesterday reminding me to take all my meds, imuran included, per doctor’s orders. The IBD researchers suspect that a flare up will put us at greater risk for being very sick from coved 19 versus if we are well while on a thiopruine or biologic and exposed to the virus. Basically he said no one really knows, wash your hands, limit your exposure to the general public and consider ourselves part of the high risk group. Didn’t make my day, but I trust his knowledge and am trying to follow his advice.

Thanks, HardEvidence -- appreciate any updates you can give us

The_Z_Man said...
I was on Immuran for the better part of 15 years and only recently switched to Enbrel, as my 300mg of Immuran for 15 years was putting me at high risk of certain blood cancers.

My doctor told me to keep on with my Enbrel injections, and actually -- as it turns out, China is treating it's patients with immune suppressors that are typically used for people like us... those with autoimmune and arthritic diseases.

You can google this, so far they are having lifesaving results with Actemra, and they have also been experimenting with Remicaid, Humera, and several others. Actemra has actually been approved in China for fighting this virus.

As all of you know, most of us got our autoimmune diseases in the first place because we had something else -- some virus or bacterial infection that caused said storm and turned our own immune systems against us.

The cytokine storm created in severe reactions to the Covid 19 virus - basically causes the immune system of the body to hyperventilate and attack the lungs -- so the end result of this virus is much like what we all deal with - except in one giant gush that permanently damages or kills a person's lungs.

Ironic, that we who are all so sick and having to take immune suppressors and worrying about this, may actually, in this one case with this virus, be better off than the general population... very strange to think, but that's what it's starting to look like.

Let's just all be thankful that this isn't an outbreak of a new strain of TB....

See my post below, as i tend to think you are correct about the connectionS between

viral infections -cytokene storm-getting immune reaction and then chronic one like psoriatic arthritis
being on immune suppressant therapies with biologics (eg Humira or the pill Otezla) and while more vulnerable to new infection because of the meds ALSO being protected by them against overreactions that kills covid-19 patients (lungs get inflamed)

As far as I know, they have had limited success with Actemera, and little to no success stopping it with TNF inhibitors like Enbrel, Remecaid, et.

But part of that may be TNF's take weeks to build up in the system. For example, my Sed rate without treatment typically runs between 110 and 150... Immuran would lower it, best case, into the high 80's.. but I usually ran about 90 to 100 with Immuran.

After my first shot of Enbrel it dropped to 75... after my 3rd shot I was down to 55. 6 weeks of Enbrel shots and I was down into the 30's and they took me off the immuran completely.

By 3 months my sed rate was 5... perfectly normal and healthy, as if I had no arthritis at all.

Would one of these TNF drugs work on a patient with Covid 19? maybe in some case... but these severely ill people do not have 6 weeks or even 2 or 3 weeks to find out, so I very much doubt that any of our biologicals will be viable treatments.

From what I read, Actemera acts differently than our meds, and much faster -- which is why it might work on some patients, but overall that anti-malerial drug seems to produce better results. In Germany they are putting together cocktails of everything and just throwing it at their patients. The German healthcare system's method is typically to medicate the crap out of you and force feed you antibiotics and make sure you finish every darn pill out of penalty of death (because of some severe drug resistant strains of flu they had post WW2) and that German method seems to be working compared to what the rest of Europe is doing

German Doctor: "Hey our massive cocktail of every known treatment on the planet might crippled you, blind you, give you a stroke, or leave you with hair loss, a ruined stomach, a destroyed kidney, and having to use an ostomy bag the rest of your life, but by God we are not going to let this Coronavirus kill you!"

You have to admire the big cajones those German doctors have...

Also, I think it is highly doubtful that methotrexate or Immuran alone would do anything to help Covid 19, as those drugs weaken the immune system and reduce red and white blood cell counts by significant margin compared to TNF 1 inhibitors.

Again, don't do any darn thing with your treatments on your own, ask your physician, all the way as that physician is the one responsible for you.

I will take my Enbrel shots as my doctor orders, and I have a tiny hair of a confidence they actually might help me if I contract this disease.

But all of this is in flux right now... we still really don't know the whole skinny.

Hard to weigh the benefit of immune suppression to potentially prevent a cytokine storm vs the risk that the immune response is too weakened to fight off Covid.

"Combining COVID-19 patient data and prior work on Vit D and CRP levels, we show that the risk of severe COVID-19 cases among patients with severe Vit D deficiency is 17.3% while the equivalent figure for patients with normal Vit D levels is 14.6% "

Another beat up, and misinterpretation of data.