What To Know About Immunosuppressants and COVID-19

A person who is immunocompromised has a weakened immune system. Immunosuppressants are medications that can cause the body's immune system to be weaker than usual, making you immunocompromised.

People who are immunocompromised in some way can have a higher likelihood of getting sick from SARS-CoV-2, the virus that causes COVID. Here's everything you need to know about taking immunosuppressants, including what they treat and how they are connected to COVID.

What Are Immunosuppressants?

Immunosuppressants "suppress" the immune system. In other words, these drugs either turn off or reduce the body's typical immune response, which can involve components like inflammation and mobilization of white blood cells to protect the body.

Types

There are several classes of immunosuppressants, with each type working in different ways for different conditions, including:

• Alkylating agents: cyclophosphamide
• Anti-CD20 (monoclonal antibody) therapy: rituximab, obinutuzumab
• Antimetabolites: mycophenolate mofetil (MMF), azathioprine
• Calcineurin inhibitors: tacrolimus, cyclosporine
  
• Complement inhibitors: eculizumab, ravulizumab
• Corticosteroids, or steroids for short: prednisone, methyl-prednisolone
• Immunomodulatory drugs: intravenous immune globin (IVIG)

What Do They Treat?

Immunosuppressants are commonly used after organ transplants so the body doesn't reject the new organ, but they're also important in the treatment of conditions such as:

• Asthma
• Certain cancers, like chronic lymphocytic leukemia and non-Hodgkin's lymphoma
• Crohn's disease
• Gout flares
• Hives
• Lupus
• Malaria
  
• Psoriasis
• Psoriatic or rheumatoid arthritis
• Ulcerative colitis

Side Effects

Various side effects can occur and may differ depending on the immunosuppressant taken. In general, possible side effects a person might experience are:

• Acne
• Anemia
• Back pain
• Bleeding
• Constipation
• Cough
• Dry skin
• Fatigue
• Fever
• Headaches
• Hypertension, or high blood pressure
• Itchiness
• Nausea or vomiting
• Shortness of breath
• Rashes
• Tremors

You might also experience serious side effects when taking immunosuppressants. Those side effects may be:

• Cardiac arrest
• Encephalopathy—conditions that may cause problems with the brain
• Meningitis
• Necrosis—the death of organ or tissue cells
• Pulmonary edema, or having too much fluid within the lungs
• Sepsis

Immunosuppressants and COVID-19

Being immunocompromised—or having a weakened immune system—or being immunosuppressed affects your body's ability to defend itself from many pathogens. Taking immunosuppressants could put you at an elevated risk of getting COVID—depending on the severity of your health condition.

Individuals in an immunocompromised state are more susceptible to critical sickness due to COVID. People who are moderately or severely immunocompromised also have an increased risk of severe effects from COVID. In other words, some immunocompromised individuals will be more at risk for COVID.

Recommendations

It's important to practice CDC guidelines regarding COVID if you're immunocompromised, like:

• Avoiding people who are sick
• Engaging in proper handwashing techniques
• Getting vaccinated
• Taking precautions if you have to travel
• Wearing masks

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.

Also, 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. For example, one review indicated that individuals taking immunosuppressants were, across the literature, instructed against sudden discontinuation of their medication if they had not been infected with COVID.

Always talk with a healthcare provider about pausing or reducing immunosuppressive treatment, and never stop a medication without provider consultation. The decision to decrease or stop a medication's use depends on your medical history and condition. For instance, a provider may advise you not to pause a medication if you have a severe autoimmune disease.

A Quick Review

Immunosuppressants are medications that decrease or inhibit an immune response. These medications are often treatments for conditions like Crohn's disease or lupus in addition to being used during transplant surgeries.

People who are immunosuppressed or immunocompromised have a higher risk of getting sick from a COVID infection and experiencing severe effects. It's an individual decision to pause or reduce your immunosuppressive treatment as it pertains to COVID, but talk with a healthcare provider before making that decision.

The information in this story is accurate as of publication. 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.