However, the World Health Organization (WHO) released a statement on its Twitter account indicating that, based on currently available information, it does not recommend against the use of ibuprofen with respect to prevention of COVID-19.5 Dr. Calabrese states she agrees that, as of now, not enough data exist to recommend patients stop taking NSAIDs and that no solid data indicate that stopping NSAIDs decreases the risk of severe or fatal COVID-19.
The ACR guidance document indicates NSAIDs may be continued for the ongoing treatment of stable patients in the absence of infection, with or without SARS-CoV-2 exposure. However, in the context of documented or presumptive COVID-19 infection, the guidance indicates NSAIDs should be stopped for patients with severe respiratory symptoms.
Two other medications that have been discussed widely in the news are hydroxychloroquine and chloroquine, which have demonstrated anti-viral activity against SARS-CoV-2 in vitro and in small, poorly controlled or uncontrolled clinical studies.6-8 Despite these limited and inconclusive data, the publicity surrounding these medications has resulted in a global run on these drugs, resulting in shortages at many pharmacies across the country and difficulty for patients with such conditions as lupus or rheumatoid arthritis to obtain prescription refills.
Dr. Calabrese explains that, although the pharmacokinetics of hydroxychloroquine may allow gaps in therapy of one to two weeks to be tolerable (the terminal half-life of this medication is 40–50 days), patients may need to temporarily space out the interval of dosing or lower the daily dose to prevent running out of the medication altogether.9
Dr. Calabrese also notes rheumatologists should be judicious in ensuring that refills are given when appropriate and not far in advance of when they are due. Rheumatologists may want to consider alternate medications for patients who have been trialed on hydroxychloroquine in the past, did not respond and are now requesting re-initiation of this treatment.
The ACR also offers recommendations regarding the allocation of hydroxychloroquine and other resources during the COVID-19 pandemic, as well as advice for talking to patients about hydroxychloroquine shortages.
In an article published on March 31 in Annals of Internal Medicine, Jinoos Yazdany, MD, MPH, and Alfred Kim, MD, PhD, recommend that “manufacturers, clinicians, pharmacies, health systems, and governmental health agencies continue to coordinate an aggressive response to ensure that antimalarial drug use is appropriately managed during the COVID-19 pandemic.”10
Although much remains to be learned about the treatment of COVID-19, it is notable that, on March 3, China’s National Health Commission (NHC) included tocilizumab in its seventh updated diagnosis and treatment plan for COVID-19, and this prompted Genentech to initiate a phase 3 trial, named COVACTA, to evaluate tocilizumab as a treatment for adults with severe COVID-19.11
