I think there are actually three questions in there, and I’ll break them down. One is, do immune suppressive medications make it more likely that one will contract the infection? The second is, does it prolong the illness? And then the third is, does it make the illness more severe? And they’re separate issues.
So, the first question: do immune suppressive medications make it more likely for you to be infected? The answer is, we think yes. We think so. If you compromise the immune system, it should make it more likely that an infection could take hold. Now, rituximab does not suppress the entire immune system, it just removes B cells from the blood. But patients who use rituximab based on B cells in their mucosa, in their sinuses, and their lungs, and the B cells are doing their job there. So, it’s not clear if rituximab predisposes to infections as maybe other medications do.
Imuran, which is azathioprine, Cellcept, which is mycophenolate, and methotrexate, they all impair metabolic function of white blood cells. And that occurs systemically. Therefore, it’s certainly possible that there are some medications that can predispose to infections, and some that maybe don’t.
We don’t have data yet coming out of China, or Italy, or Spain, or any other hotspots that suggest that this is the case. But I would caution you that a lot of these hotspots are basically like war zones, where they’re not collecting all the data. So, maybe some of those patients who are dying in the street in Spain, maybe some of them are on immune suppression. We just don’t have that data yet.
The second question is, does immune suppressive medication prolong the illness? Possibly, again, yes. We, we’ve seen that with mycophenolate and the standard flu. Instead of a two-week infection, and staying home for two weeks, a lot of my patients stay home for three weeks when they get the flu. That’s entirely observational. There’s been no blinded studies to prove that. But those two things certainly make sense. And that’s how we’ve been warning our patients. But we have not seen data to support either one of those yet. So, we’re not too worried about it right now.
The third question is, does it make the outcome more severe if you’re on immune suppressive medication? The answer to that is, probably no. Because what we’re seeing across the world is that the best outcomes are those who suppress the immune system in the severe stage. To prevent that overwhelming immune response, we know that steroids are being tested.
Eculizumab, which is Soliris, a drug used for NMO, that’s being tested. Tocilizumab, which is a drug used in NMO, and sepsis, and cytokine storms. That’s being tested. So, if you’re on any of those medications, maybe you’re more likely to get the infection, maybe it’s more likely to be prolonged, but it’s not more likely to result in a bad outcome, in terms of the rationale of using these medications.