Table I.
Drug class | Mechanism of action | Drug name | Risk | Comments/considerations∗ |
---|---|---|---|---|
Classic immunosuppressants | ||||
Inhibits NF-κB | Corticosteroids | Likely concerning risk | Consider stopping when viral symptoms present especially with known or potential exposure | |
Calcineurin inhibitor | Tacrolimus | |||
Cyclosporine | ||||
Antimetabolites | Inhibits DNA replication | Mycophenolate mofetil | ||
Azathioprine | ||||
Methotrexate | ||||
Immunomodulators | ||||
Monoclonal antibodies | TNF-α inhibition | Infliximab | Likely moderate risk | Continue if viral symptoms are mild, consider stopping if viral symptoms worsen or high fever develops |
Receptor fusion protein | Etanercept | |||
Monoclonal antibodies | Certolizumab | |||
Monoclonal antibodies | Adalimumab | |||
IL receptor modulators | IL inhibition | Anakinra (IL-1) | ||
Monoclonal antibodies | Dupilumab (IL-4) | Likely low risk | Continue unless severe symptoms present | |
Monoclonal antibodies | Brodalumab (IL-17) | Likely moderate risk | Continue if viral symptoms are mild, consider stopping if viral symptoms worsen or high fever develops | |
Monoclonal antibodies | Secukinumab (IL-17a) | |||
Monoclonal antibodies | Ixekizumab (IL-17a) | |||
Monoclonal antibodies | Ustekinumab (IL-12/23) | |||
Monoclonal antibodies | Guselkumab (IL-23) | |||
Monoclonal antibodies | Anti-CD20 antibody | Rituximab | Likely concerning risk | Consider stopping when viral symptoms present especially with known or potential exposure. |
PDE4 inhibition | Apremilast | Likely low risk | Continue unless severe symptoms present |
IL, Interleukin; NF-κB, nuclear factor κB; PDE4, phosphodiesterase 4.
General considerations only, medication use should be considered based on each individual patient's risk and disease profile.