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COVID-19 and immunosuppression: a review of current clinical experiences and implications for ophthalmology patients taking immunosuppressive drugs
  1. Zheng Xian Thng1,
  2. Marc D De Smet2,
  3. Cecilia S Lee3,
  4. Vishali Gupta4,
  5. Justine R Smith5,
  6. Peter J McCluskey6,7,
  7. Jennifer E Thorne8,
  8. John H Kempen9,10,
  9. Manfred Zierhut11,
  10. Quan Dong Nguyen12,
  11. Carlos Pavesio13,
  12. Rupesh Agrawal1,13
  1. 1 Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore
  2. 2 Ophthalmology, MIOS, Lausanne, Switzerland
  3. 3 Ophthalmology, University of Washington, Seattle, Washington, USA
  4. 4 Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Advanced Eye Centre, Chandigarh, India
  5. 5 College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
  6. 6 Department of Medical Retina and Uveitis, Sydney Eye Hospital, Sydney, New South Wales, Australia
  7. 7 Save Sight Institute, Sydney, New South Wales, Australia
  8. 8 Divsion of Ocular Immunology, Johns Hopkins Wilmer Eye Institute, Baltimore, Maryland, USA
  9. 9 Department of Ophthalmology, Massachusetts Eye and Ear and Harvard Medical School, Boston, Massachusetts, USA
  10. 10 MyungSung Christian Medical Center (MCM) Eye Unit, MCM General Hospital and Myung Sung Medical College, Addis Ababa, Ethiopia
  11. 11 University of Tuebingen, Tubingen, Germany
  12. 12 Byers Eye Institute, Stanford University, Palo Alto, California, USA
  13. 13 Department of Medical Retina and Uveitis, Moorfields Eye Hospital NHS Foundation Trust, London, London, UK
  1. Correspondence to Dr Rupesh Agrawal, Ophthalmology, Tan Tock Seng Hospital, Singapore 308433; rupesh_agrawal{at}


The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in December 2019 in Wuhan city, Hubei province, China. This is the third and largest coronavirus outbreak since the new millennium after SARS in 2002 and Middle East respiratory syndrome (MERS) in 2012. Over 3 million people have been infected and the COVID-19 has caused more than 217 000 deaths. A concern exists regarding the vulnerability of patients who have been treated with immunosuppressive drugs prior or during this pandemic. Would they be more susceptible to infection by the SARS-CoV-2 and how would their clinical course be altered by their immunosuppressed state? This is a question the wider medical fraternity—including ophthalmologists, rheumatologists, gastroenterologist and transplant physicians among others—must answer. The evidence from the SARS and MERS outbreak offer some degree of confidence that immunosuppression is largely safe in the current COVID-19 pandemic. Preliminary clinical experiences based on case reports, small series and observational studies show the morbidity and mortality rates in immunosuppressed patients may not differ largely from the general population. Overwhelmingly, current best practice guidelines worldwide recommended the continuation of immunosuppression treatment in patients who require them except for perhaps high-dose corticosteroid therapy and in patients with associated risk factors for severe COVID-19 disease.

  • immunology
  • inflammation
  • drugs

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  • Contributors ZXT: data curation, drafting and editing the manuscript. MDS: conceptualisation, data curation, reviewing and editing the manuscript, supervision. CSL, VG, JS, PJM, JT, JHK, MZ, QDM and CP: reviewing the manuscript. RA: conceptualisation, data curation, reviewing and editing the manuscript, supervision.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.