Covid risk on 30mg Prednisone taper

Hi, still going through a mild flare, mainly blood and after months on rectal meds and no improvement my GI put me on a 30mg taper, down 10mg everyweek. Then 5mg.

So far so good, after the first one yesterday I’ve had 2 good bms and no blood.

My question is how risky is it right now being on a 30mg prednisone and also azathioprine?

I asked my GI but she didn’t seem very concerned at all about an increased risk.

Curious to know your opinions.

I know they treat severe covid with steroids now so possibly Im overreacting a bit?

1wish

I'm in an IBD/Covid group and we have had this conversation many times. The answer is, it depends on the person, so it's hard to know. They use steroids in some cases to help covid illness because sometimes the body's reaction to covid is what kills the person. The immune system just goes haywire. A lot of us with IBD have dysregulated immune systems. They are too strong or react to the wrong things.

Generally, prednisone is not considered a problem with covid. Other immune suppressants might be. The people who were on imuran in the group did not have more severe covid, but their covid tended to last longer. People who were already flaring tended to get slightly worse flares, maybe because covid also targets the bowels, but more likely because it triggers an inflammatory response and if you're already having one then it just adds to the pile.

The one thing that they aren't 100% sure about is long-term covid immunity while on immune suppression. A major study is currently being done in the UK on IBD patients on immune suppression who receive the vaccine, and their body's immune response. The results will be out in the autumn, if I recall right. It's possible that immune suppression prevents proper covid immunity from forming long-term, and this may have implications in how effective the vaccines are. For now, they are still vaccinating IBD patients and hoping for the best.

Over all, I would not worry too much.

That tool gave me a 0.8% risk of death on xeljanz and mesalamine.

Bear in mind that the statistics there are biased towards more severe cases because many mild and most asymptomatic are simply unregistered as the whole thing is voluntary. My sister has crohns and was on humira when she caught covid, she recovered within 3-4 weeks. I told her to ask her gastroenterologist to put her on the database but she didn't bother...

That said, if I were you I would be very careful. The use of steroids to treat covid has to be done at the right time - too early stops you from fighting the virus. So it needs to be late enough that your immune system has been activated but before a cytokene storm develops. The data on covidibd.org clearly indicate worse outcomes for patients on steroids, although it's not clear if that's from the steroids or because those are the people with active inflammation which is going to make it more difficult to fight an infection in any case.