Last updated 27 April 2020
Author: Dr Pam Collins, Independent Consultant Occupational Physician
|Age 70 or above
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|Immuno-suppressants;- any two agents within the following classes:
methotrexate, azathioprine, mycophenolate (mycophenolate mofetil or mycophenolic acid), ciclosporin, fumaric acid esters (or dimethyl fumarate), hydroxycarbamide, 6-mercaptourine, leflunomide, cyclophosphamide, tacrolimus, sirolimus and thalidomide.
Biologic/monocolonal medications include –all anti-TNF drugs (etanercept, adalimumab, infliximab, golimumab, certolizumab pegol and biosimilar variants of all of these, where applicable); IL17/IL17Ra agents (secukinumab; ixekizumab; brodalumab); P40/P19 (ustekinumab; guselkumab, tildrakizumab, risankizumab) anti B cell (rituximab in last 12 months, belimumab); IL6 agents (sarilumab, tocilzumab); abatacept; IL1 (canakinumab, anakinra);
Dupilumab possibly lower infection risk than other drugs)
novel small molecule immunosuppressants
apremilast; all JAK inhibitors (e.g.) baracitinib, tofacitinib
• dose of ≥ 20 mg (or 0.5 mg/kg) prednisolone (or equivalent) per day for more than 4 weeks
• dose of ≥ 5 mg prednisolone (or equivalent) per day for more than 4 weeks plus at least one other immunosuppressive medication, from class 1, 2 or 3 drugs as listed above
Cyclophosphamide at any dose orally or if received IV dose within last 6 months
Rituximab or infliximab when prescribed primarily for skin conditions (e.g. psoriasis or pemphigus)
|Well-controlled patients with minimal disease activity and no co-morbidities
single agent, standard oral immunosuppressants, class 1, 2 or 3
single biologic (e.g. anti-TNF, IL17 agent)class 2 plus methotrexate at a standard dose
single agent standard oral immunosuppressant class 1 plus hydroxychloroquine / sulfasalazine.
|Medications on the following list alone or in combination:
• Topical skin treatments (creams, gels, etc).
• 5-ASA medications (e.g. mesalazine)
• Only inhaled or rectally administered immunosuppressant medication, e.g. steroid inhalers
Risk of severe illness or death if contracts COVID-19. Read more
Likely to need hospitalisation if contracts COVID-19, with protracted illness and heavy NHS burden. Read more
Increased risk compared with healthy individual but should recover.
No greater risk than healthy individual.