Rheumatologists are familiar with the everyday use of immunomodulatory drugs. These are designed to treat the inflammation caused by autoimmune diseases such as rheumatoid arthritis. In 2020, a EULAR taskforce was set up to develop a set of new points to consider to give guidance and advice on the best way to use these medicines to treat COVID-19. These have now been updated for 2021 to include the latest published evidence.
In total, there are two overarching principles and 12 points to consider. These overarching principles remain unchanged from the original publication, and stress that the picture of SARS-CoV-2 infection can be very different in different people. Infections range from asymptomatic or mild disease to severe or fatal. People with COVID-19 may need different treatment approaches, including antiviral medicines, oxygen therapy, anticoagulation and/or immunomodulatory treatment at different stages of the disease.
The 12 points to consider focus on immunomodulatory therapy, and how we might use existing medicines from the field of rheumatology to treat severe COVID-19. These give specific advice about which treatments to use at what stages of the disease. Overall, four of the points are unchanged from the 2020 version, four are modified, and four are new. Among immunomodulatory drugs useful for treating severe COVID-19, WHO has provided a strong recommendation for using dexamethasone and anti-IL-6 receptors antibodies.
The picture is changing very quickly, which means there are still some areas of uncertainty. EULAR will continue to update the advice in response to increasing knowledge and evidence about the disease, its treatment, and the impact of COVID-19 vaccines.
These findings do not apply to people living with RMDs who are taking immunomodulatory treatments for their rheumatic disease. Separate recommendations are available for the management of people with RMDs in the context of the pandemic.