An analysis of data from more than 3 million insured U.S. patients found that nearly 3% take immunosuppressive drugs, including chemotherapy medications and steroids such as prednisone.
The study authors said there are many immunosuppressive drugs that may not significantly affect COVID-19 risk, but steroid medications do appear to increase the risk of severe illness and hospitalization from COVID-19. Evidence has suggested that these drugs may also hamper the effectiveness of COVID-19 vaccines.
The study found that two-thirds of adults aged 18-65 took an oral steroid at least once, and more than 40% took steroids for more than 30 days over the course of a year.
"This study gives us previously unavailable information about how many Americans are taking immunosuppressive medications," said lead author Dr. Beth Wallace, a rheumatologist at Michigan Medicine-University of Michigan in Ann Arbor.
Consumers should consult with their doctors
There are a number of diagnoses that can result in the need for a person to take drugs that can render them immunocompromised. The most common diagnoses are cancer, immune-mediated conditions, such as inflammatory bowel disease and autoimmune diseases like rheumatoid arthritis, and skin conditions like eczema and psoriasis.
More research is needed to fully understand the effects of the drugs on COVID-19 vaccines, Wallace said.
"We don't have a full picture on how these drugs affect the vaccine's effectiveness, so it's difficult to formulate guidelines around vaccinating these patients," Wallace said. "Until we know more about this, we really won't be able to say if immunosuppressed people are actually protected.”
The Centers for Disease Control and Prevention doesn’t currently offer specific recommendations for this group of people, she added.
"The CDC acknowledges this cohort might not be as protected as other fully vaccinated people, but there are no set recommendations for what precautions they should take," Wallace said. "For now, this is going to be an individual decision people make with their doctor."
In the age of the coronavirus, Wallace said providers may want to consider being less liberal with how often they prescribe oral steroids -- and be sure to consider the minimum dose and duration when they do feel it’s necessary to prescribe them.
She added that sometimes oral steroids can be substituted with other treatments, especially for short-term conditions like bronchitis or allergic reactions.