Do we need to stop immunosuppressive medications for alopecia areata patients with mild COVID?

Consultation with the Prescriber is Number 1, but Most Patients Probably Do Not Need to Stop

A important dilemma for patients with autoimmune hair loss conditions who acquire COVID 19 infection is whether or not they should stop any immunosuppressants they are taking. The view in the public is “I want to give my immune system the best fighting chance!”

The reality is this is not quite accurate and things are much more complicated that this simple view - especially when we consider that immunosuppressants are used to treat COVID 19 and prevent an active immune system from destroying health tissues. For example, the FDA has authorized the emergency use of baricitinib to treat COVID-19 in hospitalized adults and pediatric patients 2 years or older requiring supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ECMO).

To Stop or Not to Stop Immunosuppressants for Alopecia Areata

A nice study from almost 1 year ago, showed that in cases of more mild COVID 19, stopping immunosuppressants migth not be so necessarily. The study was not a controlled study so we need to be cautious as we interpret the data.

Flanagan and colleagues showed that immunosuppressive therapies used for AA did not affect risk of acquiring COVID 19 or being hospitalized.

They analyzed survey responses of 673 patients. 91 % were not using immunosuppressants and 8.7 % were using immunosuppressants. The 3 most common systemic immunosuppressants in this study were JAK inhibitors and oral steroids followed by methotrexate.

When comparing patients who were prescribed immmunosuppressants and patients who were not prescribed immunosuppressants, the authors found there were no significant differences in COVID-19 testing, positive COVID results, or hospitalization between groups. It’s important to note that patients in this study had mild disease. None of the surveyed participants required supplemental oxygen, intensive care unit (ICU) admission or treatment with hydroxychloroquine, azithromycin, dexamethasone, or remdesivir.

Conclusions

All in all, this study did not identify a significant difference in outcomes in patients with mild COVID according to whether or not they were on systemic immunosuppressants or not. It’s always important for any patient with alopecia areata with COVID 19 to consult their physician if they acquire COVID 19 in order to determine the best specific plan for their situation. However, the vast majority of patients with mild disease can continue treatment.

REFERENCE

Flanagan et al. Immunosuppressive therapies for alopecia areata during COVID-19: A cross-sectional survey study Dermatol Ther 2021 Mar;34(2):e14762.

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