Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore.
Ophthalmology, MIOS, Lausanne, Switzerland.
Br J Ophthalmol. 2021 Mar;105(3):306-310. doi: 10.1136/bjophthalmol-2020-316586. Epub 2020 Jun 12.
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in December 2019 in Wuhan city, Hubei province, China. This is the third and largest coronavirus outbreak since the new millennium after SARS in 2002 and Middle East respiratory syndrome (MERS) in 2012. Over 3 million people have been infected and the COVID-19 has caused more than 217 000 deaths. A concern exists regarding the vulnerability of patients who have been treated with immunosuppressive drugs prior or during this pandemic. Would they be more susceptible to infection by the SARS-CoV-2 and how would their clinical course be altered by their immunosuppressed state? This is a question the wider medical fraternity-including ophthalmologists, rheumatologists, gastroenterologist and transplant physicians among others-must answer. The evidence from the SARS and MERS outbreak offer some degree of confidence that immunosuppression is largely safe in the current COVID-19 pandemic. Preliminary clinical experiences based on case reports, small series and observational studies show the morbidity and mortality rates in immunosuppressed patients may not differ largely from the general population. Overwhelmingly, current best practice guidelines worldwide recommended the continuation of immunosuppression treatment in patients who require them except for perhaps high-dose corticosteroid therapy and in patients with associated risk factors for severe COVID-19 disease.
严重急性呼吸综合征冠状病毒 2(SARS-CoV-2)于 2019 年 12 月在中国湖北省武汉市出现。这是自 21 世纪以来第三次也是最大的冠状病毒爆发,前两次分别是 2002 年的 SARS 和 2012 年的中东呼吸综合征(MERS)。超过 300 万人受到感染,COVID-19 已导致超过 217000 人死亡。人们担心在大流行之前或期间接受过免疫抑制药物治疗的患者会更容易感染 SARS-CoV-2,他们的免疫抑制状态会如何改变他们的临床病程?这是一个包括眼科医生、风湿病学家、胃肠病学家和移植医生在内的更广泛医学专业必须回答的问题。SARS 和 MERS 爆发的证据在一定程度上表明,免疫抑制在当前的 COVID-19 大流行中基本是安全的。基于病例报告、小系列和观察性研究的初步临床经验表明,免疫抑制患者的发病率和死亡率可能与普通人群没有太大区别。绝大多数情况下,全球目前的最佳实践指南建议除了可能需要大剂量皮质类固醇治疗和伴有 COVID-19 严重疾病相关风险因素的患者外,继续对需要免疫抑制治疗的患者进行治疗。
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