Consensus guidelines on immunomodulatory therapy in times of COVID-19 in very high-risk patients* (n=139)
| Healthy patients | Healthy patients with contact | Sick patient—COVID-19 suspected | Sick patient—COVID-19 positive | |||
|---|---|---|---|---|---|---|
| Oral corticosteroids | Pt not on oral corticosteroids | To be started | 80 (57.6%) | 40 (28.8%) | 12 (8.6%) | 9 (6.5%) |
| Pt on low-dose oral corticosteroids | To be maintained | 112 (80.6%) | 66 (47.5%) | 31 (22.3%) | 27 (19.4%) | |
| To be decreased | 43 (30.9%) | 84 (60.4%) | 105 (75.5%) | 110 (79.1%) | ||
| To be tapered and stopped | 33 (23.7%) | 73 (52.5%) | 102 (73.4%) | 107 (77%) | ||
| Pt on higher-dose oral corticosteroids | To be maintained | 74 (53.2%) | 35 (25.2%) | 9 (6.5%) | 7 (5%) | |
| To be decreased | 72 (51.8%) | 98 (70.5%) | 124 (89.2%) | 126 (90.6%) | ||
| To be tapered and stopped | 43 (30.9%) | 80 (57.6%) | 108 (77.7%) | 115 (82.7%) | ||
| Intravenous methyl prednisolone | To be started | 57 (41%) | 24 (17.3%) | 9 (6.5%) | 5 (3.6%) | |
| Local corticosteroids | Pt not on oral corticosteroids | To be preferred to systemic therapy | 106 (76.3%) | 121 (87.1%) | 123 (88.5%) | 121 (87.1%) |
| Pt on low-dose oral corticosteroids | To be preferred to increasing the dose of systemic therapy | 113 (81.3%) | 127 (91.4%) | 126 (90.6%) | 124 (89.2%) | |
| Conventional IMT | To be started | 78 (56.1%) | 30 (21.6%) | 5 (3.6%) | 2 (1.4%) | |
| To be maintained | 111 (79.9%) | 60 (43.2%) | 21 (15.1%) | 12 (8.6%) | ||
| To be decreased | 41 (29.5%) | 84 (60.4%) | 118 (84.9%) | 126 (90.6%) | ||
| To be stopped | 25 (18%) | 59 (42.4%) | 116 (83.5%) | 125 (89.9%) | ||
| Biologics | To be started | 64 (46%) | 26 (18.7%) | 11 (7.9%) | 8 (5.8%) | |
| To be continued | 109 (78.4%) | 60 (43.2%) | 17 (12.2%) | 11 (7.9%) | ||
| To be stopped | 30 (21.6%) | 74 (53.2%) | 118 (84.9%) | 124 (89.2%) | ||
| Tocilizumab | To be started | 72 (51.8%) | 46 (33.1%) | 41 (29.5%) | 42 (30.2%) | |
| To be continued | 115 (82.7%) | 90 (64.7%) | 63 (45.3%) | 62 (44.6%) | ||
| To switch to | 47 (33.8%) | 38 (27.3%) | 46 (33.1%) | 52 (37.4%) | ||
Consensus for ‘No’
Consensus for ‘Yes’
*Very high-risk category: patients with uveitis or rheumatologic disease with two or more risk factors.
IMT, immunosuppressive therapy; Pt, patients.