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Biologic Infusions

This article has been updated to reflect new information as of March 23, 2020.

If you’re a #HighRiskCovid19 patient, you have many questions about the coronavirus pandemic that are unique to your chronic health condition. The Global Healthy Living Foundation and CreakyJoints are committed to helping you find the answers you need.

One common topic we keep hearing about is what to do about upcoming appointments for biologic infusions.

These immunosuppressing medications — which include infliximab (Remicade), abatacept (Orencia), ritumximab (Rituxan), tocilizumab (Actemra), and golimumab (Simponi Aria) — are critical for inflammatory arthritis, inflammatory bowel disease, psoriasis, and other conditions. They reduce inflammation, treat symptoms, and prevent long-term damage. They are administered by an intravenous infusion, usually at a doctor’s office, outpatient clinic, or hospital. They are given anywhere from once a month to once every six months depending on the medication.

These biologics are considered immunosuppressing because they work on different immune system pathways to curtail the inflammation that occurs in these chronic conditions, which can make patients more vulnerable to different kinds of infection.

It is not currently known how taking these medications specifically impacts potential risks and complications from COVID-19, as research on these patient populations is underway. But patients on these medications need to proceed with an abundance of caution based on the best medical knowledge we have right now.

Should You Stop Your Next Biologic Infusion If You’re Currently Healthy?

Right now, the answer is generally no. Current guidance from the American College of Rheumatology’s website states: “All patients should talk to their rheumatologist or rheumatology professional prior to discontinuing any of their medications. While there are no data on the influence of these medications on COVID-19, providers should follow their current practice for interrupting therapy during episodes of infection.”

It is important that you speak with your rheumatologist to make decisions jointly based on what’s happening in your community.

For example, “my rheumatologist just called me to say do not come in to the clinic for my infusion,” rheumatoid arthritis patient Eileen Davidson, who lives in British Columbia in Canada. “Two doctors have been exposed to COVID-19.” Her provider is switching her to a self-injectable version of the medication, tocilizumab (Actemra), so she can administer it to herself at home.

However, it is critical that you do not cancel any biologic infusions without discussing it with your provider. They are looking out for your best interest and have your health and safety in mind.

In some areas of the country, rheumatologists, health systems, and local and state governments are deciding to postpone some routine care and treatment in clinics. “Here in Washington, D.C., the Department of Health recommended on March 17 that ‘non‐urgent hospital and outpatient visits, and non‐urgent dental procedures be postponed to preserve health care capacity as our community mitigation strategies work to flatten the epidemic curve,'” says rheumatologist Angus Worthing, MD, a clinical assistant professor of medicine at Georgetown University Medical Center in Washington, D.C. “With guidelines like this, some rheumatologists, clinics, and hospitals are discussing among themselves and with their patients whether to postpone biologic infusion appointments as part of social distancing, since infusions require patients to leave their homes to be physically present in clinic.”

Stopping a biologic infusion can lead to flares of your arthritis, inflammatory bowel disease, or psoriasis. So the decision doctors and patients are weighing right now: Is it better to risk a flare and reduce an immunosuppressed patient’s possible exposure to COVID-19?

Dr. Worthing shared that as COVID-19 infections increase, rheumatologists and their patients are scaling back in-person care and treatment, including infusions. “But while postponing a biologic one or two weeks might only have a low risk of causing a rheumatologic disease to flare, postponing for a longer time might increase the risk of flares,” he says. “Bottom line: In order to avoid a disease flare, I think it’s best that patients continue to receive biologic infusions at a time that is agreed upon based on their community’s need for social distancing, their access to treatment, and their disease activity and overall health history.”

We’ve been hearing that some patients and doctors are discussing whether patients should switch from an infused biologic to one that patients can self-inject at home, so this is something else you might want to discuss with your provider.

The 2 Situations When Stopping a Biologic Infusion May Be Necessary

1) You’re sick with any fever or infection symptoms when you are scheduled for your infusion

If patients become sick with an infection, then a decision about whether to postpone the infusion is made on a case-by-case basis by you and your health care provider. Generally speaking, if someone has a fever and respiratory symptoms, we’d hold the infusion until the patient was well again, says Vinicius Domingues, MD, a rheumatologist in Daytona Beach, Florida.

2) Someone in your household has COVID-19 or infection symptoms

“To be on the safer side, if someone in your household is found to have coronavirus — thus you have a very high risk of contracting it — I would consider holding the next infusion,” says rheumatologist Leah Alon, MD, who practices in New York City.

This decision needs to be individualized to your personal situation and should be made between you and your provider.

How to Protect Yourself During an Infusion

It’s a good idea to call your provider’s office and ask about what protocols have been put in place to keep you safe, particularly if you get your infusion at a hospital. Many health care systems are actively reconfiguring their space to keep healthy patients separated from those seeking emergency care or who could have coronavirus symptoms.

“It is likely the infusion center has protocols to protect you including cleaning the chair/bed that is used as well as usually appropriately sterile materials to deliver the drug,” says Lee Simon, MD, a rheumatologist and research scientist who has served as Division Director of Analgesic, Anti-inflammatory, and Ophthalmologic Drug Products at the U.S. Food and Drug Administration (FDA).

Beyond that, it’s simple hygiene best practices. “Wash your hands before and after your visit. Don’t touch your face,” says Dr. Domingues.

As for face masks, every doctor we have been interviewing during the coronavirus pandemic has virtually the same message. “There is no indication for patients without symptoms to wear masks,” says Dr. Domingues.

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A Message from the ACR about Coronavirus Disease 2019 (COVID-19). American College of Rheumatology. https://www.rheumatology.org/announcements.

Interview with Angus Worthing, MD, a clinical assistant professor of medicine at Georgetown University Medical Center in Washington, D.C.

Interview with Leah Alon, MD, a rheumatologist in New York City

Interview with Lee Simon, MD, a rheumatologist and research scientist who has served as Division Director of Analgesic, Anti-inflammatory, and Ophthalmologic Drug Products at the U.S. Food and Drug Administration (FDA)

Interview with Vinicius Domingues, MD, a rheumatologist in Daytona Beach, Florida