The Influence of Corticosteroids, Immunosuppressants and Biologics on Patients With Inflammatory Bowel Diseases, Psoriasis and Rheumatic Diseases in the Era of COVID-19: A Review of Current Evidence

Front Immunol. 2021 Jul 8:12:677957. doi: 10.3389/fimmu.2021.677957. eCollection 2021.

Abstract

Patients with inflammatory bowel disease, psoriasis or other rheumatic diseases treated with corticosteroids, immunomodulators and biologics might face additional risk during COVID-19 epidemic due to their immunocompromised status. However, there was still no unanimous opinion on the use of these therapy during COVID-19 epidemic. Current studies suggested that systemic corticosteroids might increase the risk of hospitalization, as well as risks of ventilation, ICU, and death among patients with immune-mediated inflammatory diseases. Anti-TNF agent was associated with lower rate of hospitalization, as well as lower risks of ventilation, ICU, and death. No significant changes in rates of hospitalization, ventilation, ICU and mortality were observed in patients treated with immunomodulators or biologics apart from anti-TNF agents. The underlying mechanism of these results might be related to pathway of antiviral immune response and cytokine storm induced by SARS-COV-2 infection. Decision on the use of corticosteroids, immunomodulators and biologics should be made after weighing the benefits and potential risks based on individual patients.

Keywords: 2019-nCoV; COVID-19; SARS-CoV-2; autoimmune; biologics; corticosteroids; immunomodulators.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Adrenal Cortex Hormones / therapeutic use*
  • Biological Products / therapeutic use*
  • COVID-19 / mortality
  • COVID-19 Drug Treatment*
  • Cytokine Release Syndrome / drug therapy*
  • Cytokine Release Syndrome / mortality
  • Hospitalization
  • Humans
  • Immunity
  • Immunosuppressive Agents / therapeutic use*
  • Inflammatory Bowel Diseases / drug therapy*
  • Inflammatory Bowel Diseases / mortality
  • Psoriasis / drug therapy*
  • Psoriasis / mortality
  • Rheumatic Diseases / drug therapy*
  • Rheumatic Diseases / mortality
  • Risk
  • SARS-CoV-2 / physiology*
  • Survival Analysis
  • Tumor Necrosis Factor Inhibitors / therapeutic use*

Substances

  • Adrenal Cortex Hormones
  • Biological Products
  • Immunosuppressive Agents
  • Tumor Necrosis Factor Inhibitors