European rheumatology groups advise children remain on immunosuppressants during COVID-19
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Several rheumatology societies in Europe recommended continuing all immunosuppressant therapies as usual in pediatric patients in the face of the continued spread of COVID-19, due to the increased risk for infection associated with withdrawal and subsequent disease flare, according to a review published in Pediatric Rheumatology.
“In children, COVID-19 related disease is less frequent and less aggressive,” Francesco Licciardi, MD, of the Regina Margherita Children Hospital and the University of Turin, and colleagues wrote. “In Italy 1% of positive cases are under 18years of age, and no deaths have been recorded before 29years of age. For patients affected by rheumatic disease, despite the concerns related to the imbalance of their immune response and the effect of immunosuppressive treatments, there are still few data to understand the real consequences of this infection.”
“Major scientific societies have issued recommendations to help rheumatologists in caring for their patients,” they added. “Interestingly, some of the drugs mostly used by rheumatologists appear to be promising in critical COVID-19 infected patients, where the hyperinflammation and cytokine storm seem to drive to the multiorgan failure. Pediatric rheumatologists are expected to play a supporting role in this new front of COVID-19 pandemic, both as general pediatricians treating infected children, and as rheumatologists taking care of their rheumatic patients, as well as offering their experience in the possible alternative use of immunomodulatory drugs.”
Regarding practical guidelines for pediatric rheumatologists, the authors stated their centers have adopted several simple measures to prevent the spread of COVID-19. These include hand washing with soap or alcohol-based sanitizers, avoiding contact with individuals with respiratory symptoms, social distancing of at least 1 meter, coughing and sneezing into one’s elbow rather than the hands and advising patients to avoid touching their face.
Further, although emergency department visits should be avoided in all but strictly necessary cases, patients who develop fever or respiratory symptoms should contact their primary care physician or pediatrician, they wrote. The authors also noted that their centers have established an on-call number to answer specific questions.
According to Licciardi and colleagues, current recommendations suggest continuing all immunosuppressant therapies as usual, since medications withdrawal may cause a flare of inflammatory disease, which in turn can lead to higher infectious risk. Additionally, several prescriptions for hospital-prescribed drugs in Italy have been automatically renewed for 90 days.
Lastly, although swabs are not prescribed for asymptomatic individuals, screening for health care providers has been discussed, the authors wrote.
“These (ie, ourselves) are the next most important people to protect, since everyday contact is allowed by definition for physicians and asymptomatic people could theoretically carry the virus and potentially be a contagious source, with dangerous spread not only for children but for family contacts and in particular elderly subjects who are at risk for severe course of disease,” Licciardi and colleagues wrote. “Therefore use of personal protective equipment depending on specific clinical situations is required.”
According to the authors, pediatric rheumatologists are now daily confronted with patients and families requesting information on scheduled appointments and infusions, as well as questions on whether any change of therapy necessary due to the possible increased risk for infection.
“For the time being, children seem to be spared, at least from the more severe consequences of this infection,” the authors wrote. “All physicians dealing with patients with chronic diseases, in particular immunosuppressed subjects, should be aware of the possible risks linked to the drugs used to treat rheumatologic disorders. However, there now hints that some of these drugs might be beneficial to fight COVID-19 infection. Use of social isolation and hygienic measure are fundamental in order to decrease viral spread.” – by Jason Laday
Disclosures: The authors report no relevant financial disclosures.
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