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ALERT: Please Read This Important Message

Message to our patients on systemic therapy

Because the COVID-19 coronavirus infection is new, we do not have much data on the effects and risks of systemic medications with regard to the Coronavirus infection. What follows is our best estimate of the safety of these medications and consequent recommendations; we tend to err on the side of caution, and given the uncertainties regarding these medications in the setting of coronavirus infection generally advises avoidance of all immunosuppression when possible. Unless you have severe disease, you may wish to strongly consider not being on an immunosuppressive medication (or one with unknown degree of immunosuppression) at this time.​
Medication
Summary
Prednisone, cyclosporine, rituximab
Strongly immunosuppressive; recommend avoid unless absolutely necessary. Aggressive infection precautions (social distancing, disinfection) warranted.
Methotrexate, CellCept (Mycophenolate Mofetil)
Moderately strong immunosuppression; avoid when possible & consider discontinuation. Aggressive infection precautions (social distancing, disinfection) warranted.
Xeljanz (tofacitinib)
Moderately immunosuppressive; avoid when possible & consider discontinuation. Aggressive infection precautions (social distancing, disinfection) warranted.
TNF inhibitors (e.g. Enbrel, Humira, Cimzia, infliximab (Remicade), golimumab (Simponi), Erelzi, Amjevita, Cyltezo, etc.)
Mild immunosuppression; avoid when possible & consider discontinuation. Aggressive infection precautions (social distancing, disinfection) warranted.
IL-12 (&23) inhibitor: Ustekinumab (Stelara) 
Minimally immunosuppressive but “may” limit immune response specific to viral infection. Consider alternative therapy vs continue with aggressive infection precautions (social distancing, disinfection) warranted.
IL-17/IL-23 inhibitors: secukinumab (Cosentyx), Ilumya, Siliq, ixekizumab (Taltz), guselkumab (Tremfya)
Unknown degree of immunosuppression, but likely mild. Options include continuing therapy, holding dose until flare occurs (but risks loss of effectiveness if held for “too long”), or discontinuation. Normal infection precautions.
Apremilast (Otezla)
Not immunosuppressive; continue therapy
Acitretin (Soriatane)
Not immunosuppressive; continue therapy
Dupilumab (Dupixent), Omalizumab (Xolair)
Not known to be immunosuppressive and potential protective effects (i.e. for asthma). Currently not recommended to stop therapy. Normal infection precautions.