Table 2.
Consensus guidelines on immunomodulatory therapy in times of COVID-19 in 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 | 98 (70.5%) | 43 (30.9%) | 7 (5%) | 5 (3.6%) |
| Pt on low-dose oral corticosteroids | To be maintained | 129 (92.8%) | 77 (55.4%) | 36 (25.9%) | 28 (20.1%) | |
| To be decreased | 22 (15.8%) | 75 (54%) | 103 (74.1%) | 111 (79.9%) | ||
| To be tapered and stopped | 16 (11.5%) | 62 (44.6%) | 98 (70.5%) | 105 (75.5%) | ||
| Pt on higher-dose oral corticosteroids | To be maintained | 86 (61.9%) | 43 (30.9%) | 17 (12.2%) | 10 (7.2%) | |
| To be decreased | 63 (45.3%) | 96 (69.1%) | 123 (88.5%) | 128 (92.1%) | ||
| To be tapered and stopped | 34 (24.5%) | 70 (50.4%) | 110 (79.1%) | 118 (84.9%) | ||
| Intravenous methyl prednisolone | To be started | 73 (52.5%) | 25 (18%) | 7 (5%) | 6 (4.3%) | |
| Local corticosteroids | Pt not on oral corticosteroids | To be preferred to systemic therapy | 101 (72.7%) | 122 (87.8%) | 123 (88.5%) | 122 (87.8%) |
| Pt on low-dose oral corticosteroids | To be preferred to increasing the dose of systemic therapy | 106 (76.3%) | 121 (87.1%) | 126 (90.6%) | 122 (87.8%) | |
| Conventional IMT | To be started | 82 (59%) | 36 (25.9%) | 7 (5%) | 3 (2.2%) | |
| To be maintained | 125 (89.9%) | 72 (51.8%) | 18 (12.9%) | 11 (7.9%) | ||
| To be decreased | 18 (12.9%) | 71 (51.1%) | 116 (83.5%) | 121 (87.1%) | ||
| To be stopped | 12 (8.6%) | 49 (35.3%) | 112 (80.6%) | 123 (88.5%) | ||
| Biologics | To be started | 69 (49.6%) | 23 (16.5%) | 6 (4.3%) | 6 (4.3%) | |
| To be continued | 123 (88.5%) | 73 (52.5%) | 18 (12.9%) | 10 (7.2%) | ||
| To be stopped | 17 (12.2%) | 63 (45.3%) | 116 (83.5%) | 123 (88.5%) | ||
| Tocilizumab | To be started | 85 (61.2%) | 57 (41%) | 39 (28.1%) | 40 (28.8%) | |
| To be continued | 128 (92.1%) | 98 (70.5%) | 66 (47.5%) | 62 (44.6%) | ||
| To switch to | 44 (31.7%) | 32 (23%) | 41 (29.5%) | 45 (32.4%) | ||
Consensus for ‘No’
Consensus for ‘Yes’
*High-risk category: patients with uveitis or rheumatologic disease with one of the following risk factors: use of biologics; high doses or multiple immunosuppressives; active systemic disease associated with uveitis; presence of other co-morbidities or multisystem disease including heart, lung and/or renal involvement; neutropenia; smoking; pregnancy; older age; previous history of infection while on IMT.
IMT, immunosuppressive therapy; Pt, patients.