Does Salazopyrin Increase Risk of Severe COVID-19 in Patients?

Q: Does Salazopyrin Increase Risk of Severe COVID-19 in Patients?

Hello, thank you for your question. <br>Here are my responses： 1) Are individuals receiving immunosuppressive therapy more likely to develop moderate to severe COVID-19 if they contract the virus? --> Generally, yes. <br>However, Salazopyridine (Salsalate) has a relatively mild e

Does the use of salmeterol increase the risk of developing moderate to severe illness after infection?

Hello Doctor, I am a patient with ankylosing spondylitis, currently 18 years old.
I am undergoing stable treatment with Wankesi (60 mg per day) and Salazopyrin (1000 mg per day).
After receiving the first dose of the BNT vaccine, my stiffness worsened, which is why I added Salazopyrin, and I am currently hesitant to receive the second dose of the vaccine.
I would like to ask the doctor: 1) Are individuals receiving immunosuppressive therapy more likely to develop moderate to severe COVID-19 if they become infected? 2) Since Salazopyrin is an immunomodulator, is my understanding correct that individuals on Salazopyrin are less likely to develop moderate to severe COVID-19 compared to those on immunosuppressive therapy? Thank you, Doctor.

Jie, 10~19 year old female. Ask Date: 2022/04/11

Dr. Gao Jiankai reply Internal Medicine

Hello, thank you for your question.
Here are my responses: 1) Are individuals receiving immunosuppressive therapy more likely to develop moderate to severe COVID-19 if they contract the virus? --> Generally, yes.
However, Salazopyridine (Salsalate) has a relatively mild effect on immune function.
The literature primarily reports on the statistical outcomes of stronger immunosuppressive agents, so there is currently no definitive conclusion regarding Salazopyridine.
I believe it should be manageable.
2) Since Salazopyridine is classified as an immunomodulator, is it correct to say that individuals who contract COVID-19 while on this medication are less likely to develop moderate to severe illness compared to those on immunosuppressive therapy? --> As mentioned, I believe Salazopyridine leans more towards being an immunomodulatory drug rather than an immunosuppressive one.
Therefore, although the current evidence is incomplete, I think that even if infected, individuals on this medication are less likely to progress to severe illness.
Concerned for your health, Department of Allergy, Immunology, and Rheumatology, Changhua Hospital, Ministry of Health and Welfare.

Reply Date: 2022/04/11

More Info

When considering the impact of medications like Salazopyrin (sulfasalazine) on the risk of severe COVID-19, it is essential to understand the broader context of how immune modulation and suppression can affect the body's response to infections, particularly viral infections like SARS-CoV-2.

1. Risk of Severe COVID-19 in Patients on Immunosuppressive Therapy: Patients who are on immunosuppressive therapies, including corticosteroids and certain biologics, may have an increased risk of severe outcomes from COVID-19. This is primarily because these medications can dampen the immune response, making it harder for the body to fight off infections. However, Salazopyrin is classified as an immunomodulator rather than a strict immunosuppressant. While it does modify the immune response, it does not completely suppress it. Therefore, while there may be some increased risk for patients on immunosuppressive therapies, the risk for those on Salazopyrin may not be as pronounced.

2. Understanding Salazopyrin's Role: Salazopyrin is used to treat inflammatory conditions like ankylosing spondylitis and works by modulating the immune response rather than suppressing it entirely. This means that while it can alter how the immune system reacts, it does not eliminate the immune response. Your understanding that patients on immunomodulators like Salazopyrin may not be at the same level of risk as those on more potent immunosuppressants is generally correct. However, it is crucial to recognize that individual responses can vary widely based on overall health, the presence of comorbidities, and the specific immune profile of the patient.

3. Vaccination Considerations: The concern regarding the first dose of the BNT vaccine exacerbating your condition is valid and highlights the importance of individualized treatment plans. While vaccination is generally recommended for patients with autoimmune conditions, the decision should always be made in consultation with your healthcare provider, considering the potential benefits and risks. If you have concerns about the second dose, discussing these with your rheumatologist or primary care physician is essential. They may recommend strategies to mitigate any potential flare-ups or side effects.

4. Monitoring and Management: If you contract COVID-19, it is vital to monitor your symptoms closely. Patients with underlying conditions, including those on medications like Salazopyrin, should be vigilant about any changes in their health status. If you experience worsening symptoms or new symptoms, seeking medical advice promptly is crucial. Your healthcare provider may recommend additional monitoring or treatment options based on your specific situation.

5. General Recommendations: It is advisable to maintain open communication with your healthcare team regarding your treatment and any concerns about COVID-19. They can provide tailored advice based on your medical history and current health status. Additionally, adhering to public health guidelines, including vaccination when appropriate, practicing good hygiene, and monitoring your health, can help mitigate the risks associated with COVID-19.

In summary, while there is a theoretical risk that immunomodulatory therapies could influence the severity of COVID-19, the specific impact of Salazopyrin may be less severe than that of stronger immunosuppressants. Always consult with your healthcare provider for personalized advice and management strategies.

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