Anti-inflammatory drugs lower risk of infection

The coronavirus antibody study run by the German Centre for Immunotherapy (DZI) at Universitätsklinikum Erlangen has now been published in the scientific journal Nature Communications.

The researchers at DZI began very early on with antibody tests against the novel coronavirus, as many patients suffering from illnesses such as arthritis, inflammatory bowel disease or psoriasis take medication that inhibits inflammation and modulates the immune response. There was some concern that these patients would have a severe reaction to the novel coronavirus. The Erlangen researchers checked patients with immune-mediated inflammatory diseases (IMIDs) for clinical evidence of respiratory infections, asked if they had been in contact with anyone infected with the disease and tested them for antibodies against the coronavirus. At the same time, a large number of healthy test persons were examined within the framework of the Erlangen coronavirus antibody study.

‘We discovered that the rate of infection with the novel coronavirus across the normal population in Bavaria is currently 2.2 percent,’ says the head of the study Prof. Dr. med. Univ. Georg Schett, one of two speakers of the DZI and Director of Department of Medicine 3 – Rheumatology and Immunology at Universitätsklinikum. ‘This is a comparatively low value and probably due to strict compliance with the hygiene measures and the successful early lockdown in Bavaria. Interestingly, however, our results also show that nine out of ten infections with the coronavirus are mild, without any major symptoms. The frequency of confirmed diagnosed Covid-19 cases in Bavaria is 0.3 percent, in other words only approximately a tenth of the rate of infection in our coronavirus antibody study.’

‘A lot of people who had been in contact with the novel coronavirus showed signs of respiratory disease which were essentially not any different from other respiratory infections,’ stated Dr. David Simon and Dr. Koray Tascilar from Department of Medicine 3 – Rheumatology and Immunology at Universitätsklinikum Erlangen.

As respiratory infections are very common and only a small proportion of them are actually caused by the novel coronavirus, it is particularly important to clarify the origin of these symptoms and to test for the virus if there is any uncertainty. A loss of the sense of smell may be an exception, as this symptom was reported significantly more often by people with antibodies against the novel coronavirus.

But what happens when people take anti-inflammatory drugs for chronic diseases such as arthritis, inflammatory bowel disease or psoriasis? Originally, it was suspected that these people would react more sensitively to infections with the novel coronavirus. ‘That is not the case, however,’ according to Prof. Dr. Markus F. Neurath, DZI spokesman and Director of Department of Medicine 1- Gastroenterology, Pneumology and Endocrinology at Universitätsklinikum and Prof. Dr. Raja Atreya, consultant at the DZI and Department of Medicine 1. ‘Patients with Crohn’s disease or ulcerative colitis who take anti-inflammatory drugs appeared to be at a low risk and certainly not any higher risk of infection with the coronavirus than the general public.’

Prof. Dr. Carola Berking, Director of the Department of Dermatology at Uniklinikum Erlangen and her deputy Prof. Dr. Michael Sticherling came to a similar conclusion: ‘Patients with psiorasis, one of the most common chronic inflammatory diseases in humans, did not have a higher risk for infection with the novel coronavirus whilst receiving special anti-inflammatory medication.’

Similar results were also found for inflammatory joint diseases such as rheumatoid arthritis and Ankylosing spondylitis, as confirmed by senior physicians Dr. Arndt Kleyer and Prof. Dr. Gerhard Krönke from Department of Medicine 3 – Rheumatology and Immunology.

These results are particularly important for people suffering from inflammatory diseases, as they show that there is no crucial reason to interrupt treatment using anti-inflammatory drugs during the coronavirus pandemic and that these patients do not belong to the group of people at high risk of developing a severe form of the infection either as a result of their illness or as a result of their treatment.

The coronavirus study from Erlangen was realised within the framework of interdisciplinary collaboration between researchers at the DZI, Prof. Dr. Klaus Überla and Prof. Dr. Matthias Tenbusch from the Institute of Clinical and Molecular Virology at Universitätsklinikum Erlangen. The study was supported by Collaborative Research Centre 1181 funded by the German Research Foundation, the Federal Ministry of Education and Research (BMBF project MASCARA) and the Schreiber Foundation.

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