Posted on Authorea 24 Sep 2020 — The copyright holder is the author/funder. All rights reserved. No reuse without permission. — https://doi.org/10.22541/au.160091464.40011130 — This a preprint and has not been peer reviewed. Data may be preliminary. eprtro lt ak anansca itnigo tlat6fe n tya oea uha possible. as much as home at stay and feet N95 6 wear least hands, at unwashed of with distancing pa- mouth social and Also, mea- maintain eyes CDC. precautionary mask, touching U.S COVID-19 avoid cloth travel, the enhanced or non-essential maintain by respirator and from should advised refrain cyclosporine condition as like sirolimus, medical guidelines sures transplant, mofetil, their same mycophenolate organ of the etanercept, irrespective solid follow like rituximab transplant, to drugs rheumatoid marrow immunosuppressant advised lupus, taking also bone sclerosis, tients are like multiple transplant underly- procedures deficiencies, cells from treatment immune stem suffering undergoing genetic Patients HIV, patients cancer, immunocompromised arthritis. like for stopped [3-5]. conditions advised better be medical respiratory feels are other can ing any person Immunosuppressants measures or a nose precautionary once runny process. COVID-19 throat, again treatment sore continued fever, or be develops disease can and it well It underlying as feeling the symptoms. not providers However, is of healthcare someone infections. respective up if and consulting flare temporarily without viruses to immunosuppressants off stop lead ward dis- to can to Crohn’s not mechanism disorder, recommended autoimmune defence lymphangioleiomyomatosis. is like treat body’s it disease to the organ lung used lower prevent and to be can syndrome, Immunosuppressants response could Nephrotic immune Psoriasis, make arthritis, body’s and and Etanercept, Rheumatoid the transplantation system ease, like suppress organ immune drugs drugs solid the These Immunosuppressant during weaken [1-2]. rejection risk can system. COVID-19 severe Rituximab immune cause to can weakened and vulnerable It patients a Cyclosporine disease. Sirolimus, to the mofetil, due of morbidity cause Mycophenolate COVID-19 can in from drugs increase immunosuppressant with illness FDA, U.S infection of and to Services leading Human viruses and to Health susceptibility of Department U.S the per INTRODUCTION As pandemic. COVID-19 organ amid and disease the immunocompromised 1. with treatment, associated cancer morbidity and diseases, mortality autoimmune and the lower partners for help government therapy Increased will help immunosuppressants. drug patients with will transplant effective associated study risks about Our health awareness COVID-19 risk understand interactions. public Prevention), organisa- associated better COVID-19 drug-drug and health to action, and Control global organisations of health contraindications Disease accredited mechanism international for reactions, other properties, pharmaceutical (Centers and drug a about CDC Administration) adverse as information Drug U.S factors, immunosuppressant includes morbidity, and the on also and (Food by it guidelines Moreover, FDA mortality issued the U.S tions. discusses COVID-19, the Organisation), study with increase This Health factors also (World infection. risk WHO can of associated more duration it persons its longer immunocompromised Moreover, and to make drugs lead drugs the COVID-19. can These weaken system with virus. immune can associated weakened nCoV-2 Rituximab SARS complications and to to susceptible Cyclosporine vulnerable patients Sirolimus, make mofetil, and system Mycophenolate immune Etanercept, like drugs Immunosuppressant Abstract 2020 24, September 2 1 Talukdar Debjyoti Contraindications & Interactions Drug-Drug Associated Risks, COVID-19: with Therapy Drugs Immunosuppressant h nvriyo h etIde tS Augustine St at Indies West the of University The University Mahaveer Teerthanker 1 in Ignacio Diane , 2 n aa oa Gupta Mohan Madan and , 1 2 Posted on Authorea 24 Sep 2020 — The copyright holder is the author/funder. All rights reserved. No reuse without permission. — https://doi.org/10.22541/au.160091464.40011130 — This a preprint and has not been peer reviewed. Data may be preliminary. h uo erssfco eetr(NR.Ebe sadmrcfso rti hc ossso ua 75 human a of consists which protein to [10-12]. fusion 6.1 through portion dimeric G) from binding (immunoglobulin a varying IgG1 ligand is pH human 25mg/50mg Enbrel extracellular with of (TNFR). (p75) a sterile portion receptor kilodalton as and crystallizable) factor (fragment presented colorless necrosis Fc be clear, tumor the also appears to the linked It can which phosphate, is It chloride. vial sodium Enbrel hydrochloride, sodium use 6.5. 7.7. man- L-arginine 100mM multiple 40mg to 25mM and and 25mg like sucrose, 7.1 sucrose signs ingredients a 10mg from 1% inactive reducing of like varying contains ingredients form pH of which inactive syringe the with terms containing prefilled in tromethamine in powder presented 1.2mg lyophilized usage be and sterile of nitol can white range psori- Enbrel a spondylitis, wide as etc. ankylosing a appears psoriasis arthritis, has plaque rheumatoid which arthritis, arthritis, idiopathic Etanercept atic juvenile of polyarticular name for brand symptoms the is Enbrel Properties Pharmaceutical risks. with and associated effects risk side action, interactions, The of drug-drug in Etanercept mechanism contraindications, described . properties, COVID-19, are patients pharmaceutical for Rituximab therapy drug COVID-19 and drug the on Cyclosporine the describes effect Sirolimus, review mofetil, their The This Mycophenolate and detail. identified. Etanercept, therapy were as studies drugs such studies relevant for immunosuppressant drugs and databases various scholar globally google includes COVID-19 and of PubMed review Medline, treatment on management/ done hospital-based was search on literature online review, this associated In drugs, [6-9]. immunosuppressant interactions alcohol of drug-drug 60% METHODOLOGY and least properties at reactions 2. pharmaceutical with adverse sanitizer the contraindications, hand COVID-19, discuss use with or we seconds factors with study, 20 risk items least this personal at In for sharing water avoid and content. and soap frequently with touched hands objects wash others, household disinfect should they Moreover, 2 Posted on Authorea 24 Sep 2020 — The copyright holder is the author/funder. All rights reserved. No reuse without permission. — https://doi.org/10.22541/au.160091464.40011130 — This a preprint and has not been peer reviewed. Data may be preliminary. rnlmtssa tcncueahge niec fsldmlgace.Smlry nrli o recommended not is Enbrel Similarly, malignancies. solid of Wegener incidence from higher suffering those a for cause especially can it cyclophosphamide, taking as patients granulomatosis disease for recommended the not exacerbate is Contraindications Enbrel can & it Reactions as Adverse recommended Interactions, that not Drug-Drug recommended is stopping also Moreover, plan is infection. dose active It treatment of COVID-19. evidence [14]. of altering infections. is for active Society or there risk from British abruptly unless patients plan and high medication treatment protect (ACR) considered their to Rheumatology continue are followed should of Etanercept patients be College with should American are treatment guidelines per of reported CDC ongoing reactivation As infections or with Enbrel. tuberculosis the patients with active histoplasmosis Rheumatology, of cause coccidioidomycosis, associated Some also aspergillosis, are can candidiasis, serious [11]. like It etc. if infections discontinued infections. Fungal that be fungal recommended tuberculosis. and should latent is bacterial Enbrel It viral, then with infections. corticos- develops associated serious or through sepsis Methotrexate mortality like or immunosuppressants or infection other hospitalization with cause concomitantly can taken teroids, if Etanercept or COVID-19 the Enbrel inflammatory on and the TNF-beta Etanercept in and with role crucial TNF-alpha Associated a of Risks plays [13]. immune binding It in pathology (TNF). inhibits involved joint factor it is of necrosis It and tumor response cytokine of form. process inactivation soluble a to dimeric is leading in surface it molecules cell as (TNF) responses factor inflammatory necrosis tumor and to bind can Enbrel Action of Etanercept Mechanism of Structure Protein 1: Figure 3 \ sout, Posted on Authorea 24 Sep 2020 — The copyright holder is the author/funder. All rights reserved. No reuse without permission. — https://doi.org/10.22541/au.160091464.40011130 — This a preprint and has not been peer reviewed. Data may be preliminary. tctasln ains h s fMFi otaniae uigpennya tcncuecongenital cause can it as pregnancy during including contraindicated infections, hep- Sirolimus is the of and MMF risk reduces cardiac [15]. of increased also renal, miscarriages use at and among time The are malformations infection of MMF patients. opportunistic use period transplant and who a atic (AUC). (PML) persons over curve leukoencephalitis addition, the plasma multifocal In under progressive blood (C fasting. area while drug in the orally the concentration reduces concomi- taken of drug taken also concentration when the it hydroxide) serum of aluminium maximum Mofetil. and variation Mycophenolate (magnesium a of TC Moreover, absorption Maalox antacid the the reduces FDA, tantly U.S to the lead per also Contraindications As can & it Reactions sup- Moreover, [18-19]. Adverse with patients Interactions, COVID-19. resources transplant with Drug-Drug adequate increased organ associated MMF with solid undertake mortality staffed in taking to reduce lymphoma facilities patients advised to of with transplant and development treatment managed hepatic risk and be and high therapy should Patients cardiac considered port and are Renal, vulnerable infections. plan considered to COVID-19. treatment are patients against their of susceptibility measures of increased part precautionary to as lead MMF can taking MMF like COVID-19 drugs and Immunosuppressive the Mofetil upon Mycophenolate dependent with are associated they Risks as lymphocytes proliferation T the the inhibits and It blocks B (IMPDH). and dehydrogenase of monophosphate DNA is inosine which the inhibits (MPA) into reversibly acid and incorporates mycophenolic synthesis It to hydrolyzed metabolite. is active administration an oral upon (MMF) mofetil Mycophenolate mofetil Action Mycophenolate of of Mechanism Structure Chemical 2D 2: Figure 500mg. and 250mg of magnesium form are the tablet in mofetil mycophenolate present [15-16]. 500mg tablets etc. and with starch, 250mg orally pregelatinized a consumed in sodium, present be stearate, ingredients 2-morpholinoethyl can inactive It the name of 3.6. Some chemical pH at with medium C acidic drug - immunosuppressive formula ical an is chem- and (E)-6-(1,3-dihydro-4hydroxy-6-methoxy-7-methyl-3-oxo-5-isobenzofuranyl)-4-methyl-4-hexenoate (MMF) be mofetil not Mycophenolate should Enbrel contraindication, Properties of Pharmaceutical terms In Mofetil spondylitis, Mycophenolate [13]. ankylosing on psoriasis, sepsis. Based plaque with etc. well. patients with as to arthritis, patients treatment administered for live psoriatic prophylactic with reactions patients for adverse arthritis, to considered cause given rheumatoid be be can should can Enbrel Enbrel it trials, count. but clinical neutrophil viruses, of varicella reduction to specifically lead vaccines can it as Sulfasalazine with 23 H 31 O 7 tpyial per sawiecytliepwe ihicesdslblt in solubility increased with powder crystalline white a as appears physically It . max .Alteaoecniin r oprdwe M is MMF when compared are conditions above the All ). 4 enovo de ytei fteprns[5 17]. [15, purines the of synthesis enovo de aha fgaoienucleotide guanosine of pathway Posted on Authorea 24 Sep 2020 — The copyright holder is the author/funder. All rights reserved. No reuse without permission. — https://doi.org/10.22541/au.160091464.40011130 — This a preprint and has not been peer reviewed. Data may be preliminary. ntrso rgdu neatos ocnrto fSrlmscnices ihcnoiatueof use while Sirolimus concomitant of with concentration increase the increase can also Sirolimus can of Verapamil concentration inhibitors. interactions, or drug-drug inducers of CYP3A4/P-gp of terms nature Contraindications In the healthcare & patients the to Reactions wherein for Adverse due circumstances important [22]. Interactions, But, certain is transmission Drug-Drug in It COVID-19 interruption Sirolimus. of plan. or treatment risk of treatment or nodes high intake their reduction at lymph with to dose are continue lungs, upon due they is in decide (lymphangi- COVID-19 that It to cells LAM contracting advisable provider like is that volume). of muscle it advised expiratory risk illness, of also (forced high their growth is FEV1 at abnormal it like are Moreover, from COVID- function for kidneys suffer recommended. lung risk who as high of patients at guidelines lowering are oleiomyomatosis) CDC like patients follow which complications especially to to cause prophylactically due important can acts infection to it It susceptibility where increases 19. patients It transplant transplant. in regulatory renal immunosuppression key in for a efficient of is activation COVID-19 Sirolimus the and inhibits Sirolimus it with [20]. and immunosup- associated rapamycin) activity an Risks of generate calcineurin target to on immunophilin (mammalian effect (FKBP12), mTOR no 12 - activation has protein kinase and It binding proliferation FK inhibits complex. to and pressive binds IL-15 It IL-4, (interleukin-2), T-lymphocytes. IL-2 of like cytokines stimulates Sirolimus Action of Sirolimus Mechanism Structure Chemical 2D 3: Figure ascorbyl diglycerides, calcium glycol, and polyethylene [20-21]. tablets sucrose, stearate mono Rapamune lactose, for magnesium dioxide, ethanol, ingredients and titanium inactive are talc, sulphate, the include solution and of cellulose oral Some alcohol, microcrystalline Rapamune are etc. benzyl phosphatidylcholine in glycol, chloroform, ingredients propylene acetonitrile, palmitate, inactive The acetone, as molecular water. The such antiobiotic. C solvents macrolide is in a Rapamune,is Sirolimus as of known formula also Sirolimus drug Immunosuppressant The Properties Pharmaceutical 51 H 79 NO 13 hscly ti ffwiei oo npwee om ti soluble is It form. powdered in color in white off is it Physically, . 5 \ ott.adi loislbein insoluble also is and soutetc. Posted on Authorea 24 Sep 2020 — The copyright holder is the author/funder. All rights reserved. No reuse without permission. — https://doi.org/10.22541/au.160091464.40011130 — This a preprint and has not been peer reviewed. Data may be preliminary. ehns fAction Cyclosporine of of Mechanism Structure Molecular 2D 4: Figure blood the outside concentrations granulocytes distributed higher (33-47%), at is plasma saturates it it (41-58%), erythrocytes, largely erythrocytes and but leukocytes : in follows blood, [24-25]. while as in (4-9%), are lymphocytes lipoprotein cyclosporine and to heart (5-12%) of bound uptake liver, is The kidney, cyclosporine volume. in encephalopathy. of allergic hypersensitivity, success 90% delayed and with remarkable mediation that along cell extent shown to greater due a has rejection to immunity allograft which humoral suppresses drug It immunosuppressive transplant. allogeneic an is Cyclosporine Properties Pharmaceutical in- which Cyclosporine dermatitis. hypersensitivity exfoliative with vasculitis, suffering hypersensitivity patients angioedema, for reactions, [23]. contraindicated anaphylactic in is like dehiscence hypercholesterolemia It symptoms anastomotic hypertension, transplant. bronchial cludes edema, renal cause mor- peripheral high with cause can cause can patients it can it loss,while in commonly, it graft Most as patients and patients. transplant thrombosis transplant liver lung artery for recommended hepatic not to is due Sirolimus tality of bromocrip- use cimetidine, The telaprevir fluconazole, and [20]. diltiazem, indinavir Sirolimus like ritonavir, ( drugs like other inhibitors Wort Certain protease John tine, Sirolimus. of concentration St. the Rifapentine, crease Phenobarbital, like drugs 6 yeiu perforatum Hypericum \ ot t.cnices lo ocnrto of concentration blood increase can etc. sout, \ otsprteUSFA ti reported is It FDA, U.S the per soutAs ,Craaeiecnde- can Carbamazepine ), Posted on Authorea 24 Sep 2020 — The copyright holder is the author/funder. All rights reserved. No reuse without permission. — https://doi.org/10.22541/au.160091464.40011130 — This a preprint and has not been peer reviewed. Data may be preliminary. r50g5m il.Tep fRtxmbi . n omltduigsdu irt iyrt,sodium dihydrate, citrate 100mg/10ml sodium intravenously as using available formulated [29-31]. administered and concentration purposes be injecting 7.4 liquid by for can is free water Rituximab produced It preservative and of is 80 sterile, pH polysorbate culture. colorless and The chloride, clear gentamicin suspension genetically vials. a a antibiotic using 500mg/50ml is as the or medium it appears as contains nutrient antigen it It a CD20 and against in directed antibody. cells is kappa It mammalian monoclonal name). (brand IgG1 Rituxan as engineered known also is Rituximab Properties Pharmaceutical Cyclosporine creatinine. and Rituximab nitrogen) castor urea polyoxyethylated and (blood 28]. cyclosporine BUN to [24, of hypersensitivity levels oil from rising suffering patients patients transplant to among renal is lead contraindicated and also nephrotoxicity is (37%) can Importantly, patients it transplant Moreover, hepatotoxicity. liver higher (38%), as (25%). and patients re- drugs nephrotoxicity transplant CoA pharmaceutical cardiac cause HMG other among any drug-drug can noted aliskiren, that with sirolimus, cyclosporine important cyclosporine like is of administering drugs It concentration to of etc. prior clearance etoposide, an reviewed reduced prednisolone, is are colchicine, to it interactions digoxin, as lead statin, CYP3A4 also like of can inhibitors substrates ductase It are which CYP3A4. comedications of For of [26-27]. inhibitor concentration virus. doctor plasma increase the the can to to Contraindications Cyclosporine visits exposed & frequent immunosuppressive the are avoid Reactions certain to recipients to Adverse of recommended transplant Interactions, Due as dose kidney Drug-Drug dose formation. or the the liver lymphoma reduce continue heart, and can significantly they are infection to outpatients, who for corticos- advised patients risk with is wherein increases Cyclosporine it agents administer It pandemic, to COVID-19 patients. advised is transplant current It organ therapy. in immunosuppressive inhibits teroids of and part and interleukin-2 is COVID-19 T-helper Cyclosporine or and (TCGF) Cyclosporine cycle. factor with cell growth associated of T-cell Risks phase [24]. releases G1 production It and lymphokine G0 and suppressed. the T-lymphocytes are in lymphocytes cells specific T-suppressor inhibits reversibly Cyclosporine 7 Posted on Authorea 24 Sep 2020 — The copyright holder is the author/funder. All rights reserved. No reuse without permission. — https://doi.org/10.22541/au.160091464.40011130 — This a preprint and has not been peer reviewed. Data may be preliminary. ylsoieCVD1 nvtosuisso niiino h elcto ftecrnvrssa ylsoiesosatvrlatvt gis ait fRAvrss tas hw ciiyaantbtcrnvrs[62] tcncueavreratosfrlvr inyadhattaslne ainslaigt ea yfnto,teo,hruim yetninec tcnas edt lmrlrcplaytrmoi ihCcoprn n as rf alr.Ccoprn a locuehpmgeei edn ocnusosec[4 8.Du-rgitrcin ewe ylsoieadhra itr upeet tJh’ otcncuerjcino rnpatdogn,gatls n euto fccoprn nbodcnetain SI rg ienpoe n uidcwt ylsoiecndces ea ucin[4 28] [24, function renal decrease can Cyclosporine with sulindac and naproxen like drugs NSAID concentration. blood in cyclosporine of reduction and loss graft organs, transplanted of rejection cause can Wort St.John’s supplement, dietary herbal and Cyclosporine between interactions Drug-drug [23] concentration blood Sirolimus decreases rifapentine carbamazepine, rifapentine, Phenytoin, concentration. blood Sirolimus increase can etc. C hepatitis HIV, like inhibitor protease fluconazole, diltiazem, cimetidine, like Drugs inhibitors. CYP3A4 with occur can Interactions Drug-Drug 23]. [20. etc vessels pulmonary lymphatics, lungs, in 28]. cells [24, muscle etc smooth convulsions of to growth leading - hypomagnesemia (LAM Lymphangioleiomyomatosis cause [13]. 33] with also etc [29, suffering can Psoriasis patients disease Cyclosporine Plaque Granulomatosis in failure. Wegener’s Arthritis, nasopharyngitis graft with Rheumatoid pain, cause suffering Spondylitis, abdominal and patients Ankylosing stomatitis, Cyclosporine in Arthritis, causes with anemia Psoriatic It thrombosis edema, from etc. capillary peripheral suffering hypertriglyceridemia glomerular diarrhea, patients infection, to nausea, in tract lead spasms, reactions urinary also muscle adverse increase, can cause cause creatinine It can can hypertension, it It etc. edema, Also, hypertension peripheral hirsutism, etc. causing weakness) tremor, by (physical dysfunction, transplant asthenia renal renal infection, to in fever, leading reactions lymphopenia, patients adverse transplanted with cause heart along can and malignancies It kidney lymphoid liver, to for leading reactions reactions adverse adverse cause cause can can It It [15] (PML) leukoencephalopathy multifocal progressive fatal 32] to - lead [31 also failure can respiratory It like patients. symptoms transplant of hepatic complication and to cardiac leading [26-27]. renal, nCoV-2 betacoronavirus in [22] SARS against volume) disease to activity lymphoproliferative expiratory susceptibility shows or forced patient’s also lymphoma (FEV1: to It of function lead development viruses. lung also cause RNA reduces can can of also It variety It It COVID-19. a disease. against with activity lung associated [18-19] antiviral underlying complications risk shows from serious the cyclosporine suffering to outweigh [11] as those leading present benefits coronaviruses specifically lymphocytes infection the the COVID-19 deplete unless as of to can medications medications replication susceptible It immunosuppressive the the more continue continue of are and to inhibition drugs guidelines advised show immunosuppressant CDC is studies taking Follow It Patients in-vitro diseases. COVID-19 complications. immune with and COVID-19 rheumatoid to with susceptible suffering patients patients transplant in and complications immunocompromised Infectious make and infections to rise give can system immune the of Oversuppression Rituximab Cyclosporine Sirolimus Mofetil Mycophenolate Etanercept 9pnei.I sascae ihicesdmriiyadmraiyseilywt neligmedical underlying with specially COVID- mortality amid and morbidity precautions increased maintain with to associated need immune is of SSc suppression It with in mofetil’s Sambataro therapies clinical pandemic. worse mycophenolate N, with immunosuppressive of Papa 19 COVID-19 develop Del role Chronic to by the vulnerability heightened study shows to Another outcomes. 2020 leading (SSc) al., [35-36]. sclerosis infection systemic et. of developing et. F system of Pignataro JW risk immunosuppressive A, Li are serious taking Minniti who or at Z, G, cancer patients also Wu Moreover, diabetes, for are C, hypertension, treatment infections. etc. disease, Zhang undergoing serious lung drugs, patients and like and conditions for influenza 2020 comorbid risk infection, with al., infection respiratory older COVID-19 upper et. study serious to along The VD cause leading virus can psoriasis Reddy contraindications. nCoV-2 Etanercept QG, and shows SARS interactions Thibodeaux 2020 to drug-drug al., ND, susceptibility reactions, Brownstone and adverse by drugs factors, conducted immunosuppressant risk of associated role its with the discusses study Our DISCUSSION COVID-19 with Risks Associated Adverse Risks, Drugs Immunosuppressant Associated COVID-19: with Interactions Therapies periph- Drug-Drug and spasm, Drugs Wegener’s Reactions muscle Immunosuppressant and (MPA) cause polyangiitis 1: 33-34]. can microscopic [29, Table it (GPA) with Moreover, polyangiitis suffering patients with but arthritis. granulomatosis in contraindications rheumatoid or any urinary etc. granulomatosis have nasopharyngitis, with nausea, bronchitis, doesn’t patients diarrhea, infection, it edema, in respiratory FDA, eral upper U.S etc. like physical per infection, reactions - As adverse tract asthenia common etc. infection, can cause neutropenia, Rituximab lymphopenia, can energy, rising fever, concomitantly. it of approved with reactions, lack not failure infusion is and renal to Cisplatin weakness of leading with syndrome signs malignancy lysis Rituximab show lymphoid tumor lym- can oliguria. cause experiencing Non-Hodgkin They or patients level if of Cisplatin. toxicity creatinine patients with fatal serum with concomitantly cause can Rituximab associated Toxicity It administered are susceptible. cisplatin. more with are toxicity (NHL) phoma renal cause can which Contraindications Rituximab B-cells & [31-32]. deplete immunity Reactions can humoral to Adverse in Rituximab guidelines requiring Interactions, functions as CDC Drug-Drug failure and COVID-19 U.S immunity respiratory follow of adaptive to to complications in leading important antibodies threatening susceptible secretes myalgia quite life more It’s from cough, patients patients makes ventilation. fever, It protect mechanical like rit- COVID-19. and leukoen- symptoms taking with intubation in-patients multifocal with associated endotracheal Moreover, progressive complications COVID-19 with contract syndrome, rate. risk lysis to mortality high tumor high at are with with uximab reactions reactions mucocutaneous infusion severe fatal cephalopathy, cause can [29]. can COVID-19 line Rituximab It ADCC and lymphoma like B-cell Rituximab cytotoxicity). human mechanisms with lymphoma) dependent certain associated histiocytic involves (complement Risks (diffuse It CDC DHL-4 the and domain. to cytotoxicity) through Fc apoptosis occurs mediated by induce in-vitro cell lysis recruited cell dependent are B which (antibody domain. Fab functions through lymphocytes effector B on immune antigen CD20 to binds Rituximab Action of Rituximab Mechanism of Structure Protein 5: Figure 8 des Reactions Adverse rgDu neatosntdwt ipai edn oftlrnltxct.I a locuetmrlsssnrm seilyi ainssffrn ihnnhdknlmhm.I a locuers nsrmcetnn rla ooiui t 2,34]. [29, etc oliguria to lead or creatinine serum in rise cause also can It lymphoma. non-hodgkin 17] with [15, suffering effective patients less in be especially may syndrome it lysis [13] as tumor vaccines malignancies cause attenuated solid also live non-cutaneous can with to It used lead toxicity. be can renal not it fatal should as to It patients leading TC). Granulomatosis cisplatin Wegener’s (Maalox with hydroxide in noted magnesium Cyclophosphamide interactions and with Drug-Drug aluminium recommended containing Not antacids infection. with serious Mofetil to Mycophenolate leading of arthritis) concentration rheumatoid reduce for can drug interactions (a Drug-Drug Anakinra with interactions Drug-drug Interactions Drug-Drug Posted on Authorea 24 Sep 2020 — The copyright holder is the author/funder. All rights reserved. No reuse without permission. — https://doi.org/10.22541/au.160091464.40011130 — This a preprint and has not been peer reviewed. Data may be preliminary. REFERENCES Design manuscript, the Review DI & Writing Design Collection, manuscript, Data the Concept, Review MMG: & Writing Collection, Data Concept, DT: prevent CONTRIBUTIONS to AUTHORS’ ways on INTEREST guidelines OF CDC CONFLICTS of aware discussed be be to FUNDING virus. patients should need nCoV-2 pertaining that temporarily SARS Patients changes recommended medications the Any to halting is providers. pandemic. exposure or It COVID-19 healthcare dosage of concerned reducing midst etc. with the like transplant, in drugs regime organ immunosuppressant reasons treatment like to treatment, several their drugs for cancer with Immunosuppressant continue prescribed disease, should are autoimmune rituximab COVID-19. and as to cyclosporine such susceptible sirolimus, mofetil, are mycophenolate drugs etanercept, immunosuppressant current taking patient’s Patients the upon based patients temporarily Overall, medication CONCLUSION respective COVID-19. halt their [40]. contracting by or of pandemic asked dosage risk COVID-19 are and the they amid 2020 condition unless reduce Rituximab al., medications to with with immunosuppressant provider et. their infection interferes NP healthcare with of it sclerosis. continue Robertson multiple risk and to from syndrome MD, serious advised family suffering Willis respiratory are populations a cyclophilin by study shows acute the cohort study also vulnerable It of severe Another among It members infection established. of [39]. multiple of be proteins risk replication or to increased viral the shows one remains of with inhibition on interactions of associated functional effect mechanism the is van Cyclosporin’s the it JC, that shows Zevenhoven-Dobbe that states AH, reports al., lupus study Wilde systemic The de including (SARS-CoV). et. H1N1 diseases [38]. coronavirus severe Y autoimmune and etc. in Meer failure Sirolimus arthritis, respiratory of der rheumatoid acute role Respiratory disease, with the East patients Crohn’s (Middle discusses manage erythematosus, MERS also to reduces study used Sirolimus The also of is application pneumonia. clinical It Shen that Y, infection. shows Hou CoV 2020 Y, al., Syndrome) Zhou et. [37]. hypertension Y pulmonary Huang to J, secondary and cardiomyopathy primary like conditions : AtnoR ivaM muoupeso rgrltdadciia aietto fCoronavirus of manifestation clinical and drug-related Immunosuppression (COVID-19) M. consider 2019 Silvia Disease COVID-19: R, Coronavirus Immunocompromised, JJ. (CDC). Antonio Manson Prevention 7. Are and RS, Control Tattersall You Disease for E, Centers If Sanchez 6. M, (CDC). Brown DF, Prevention McAuley P, and Mehta concern. health 5. Control global of Disease outbreak coronavirus novel for A GF. Centers Gao FG, 4. Hayden PW, Horby C, Wang 3. USFo rgAdministration. Drug & Food (WHO). U.S 2. Organisation Health World 1. rtn eiwtemanuscript the Review & Writing ies 09 hrpuia yohss mrcnJunlo rnpatto.22 p 3. Apr 2020 Transplantation. of Journal American hypothesis. therapeutical a 2019: disease 2020). 28;395(10229):1033-4. May Mar 18 (accessed 2020 2020 https://www.cdc.gov/coronavirus/2019-ncov/index.html; Lancet. The immunosuppression. https://www.cdc.gov/coronavirus/2019-ncov/need-extra- and https://doi.org/10.1016/S0140-6736(20)30628-0 syndromes storm COVID-19, cytokine 2020). From May 18 (accessed 2020 Yourself precautions/immunocompromised.html; Protect https://doi.org/10.1016/S0140-6736(20)30185-9 15;395(10223):470-3. Feb 2020 Lancet. The 2020). May ps://www.accessdata.fda.gov/drugsatfda tion, tp:/w.h.n/elhtpc/ooaiu;22 acse 8My2020). May 18 (accessed 2020 https://www.who.int/health-topics/coronavirus; ofnigfrti work this for funding No : Nil : : oslbl21/07550llpf 00(cesd18 (accessed 2020 docs/label/2012/103795s5503lbl.pdf; ooaiu ies 09-WrdHat Organiza- Health World - 2019 disease Coronavirus 9 ® nrl(tnret,htt- (etanercept), Enbrel | CDC, Posted on Authorea 24 Sep 2020 — The copyright holder is the author/funder. All rights reserved. No reuse without permission. — https://doi.org/10.22541/au.160091464.40011130 — This a preprint and has not been peer reviewed. Data may be preliminary. USFo rgAmnsrto.RPMN (sirolimus), RAPAMUNE Administration. Drug & Food 2019 htt- Disease COronaVirus Novel High-Risk R. a Caporali U.S F, in Mofetil, 20. Pignataro COVID-19 A, A. Minniti Nsair G, D, Sambataro Cruz N, F, Mycophenolate Papa Al-Saffar Del A, 19. Fan M, trans- kidney Kamath a P, Administration. in pneumonia Gaynor 2019 JJ, Virus Corona Hsu Novel S. 18. cha- Ghaffari Clinical P, Z. Afzal Peng Drug H, Z, Li Mahmoudi L, N, Rao Namazee X, Liu 17. L, Zhou W, Zhou W, & Liang A, Wang H, Xia Q, Zhang Z, Zhong 16. Food The R. Gerli Administration. R, Perricone U.S R, Bursi 15. AF, Bonifacio Drug G, Cafaro E, Bartoloni P, Triggianese & C, Perricone 14. Food 18 U.S (accessed 2020 TNF- 13. https://www.drugbank.ca/drugs/DB00005; Z. DrugBank, Qizhi - Etanercept L, Yun Bank.ca. Drug C, 12. Xuan Z, Jialian L, Wenwen W, Luo P, Wenxing 11. Coron- Novel W. Liao T, Bhutani SY, Chan BA, Myers VD, Reddy QG, Thibodeaux ND, Brownstone 10. USFo rgAmnsrto.NOA()Cyclosporine, NEORAL(r) Administration. Drug & Food Vaglio R, U.S Cutruzzula B, 24. Xhaferi A, Cavallo repurpos- M, C, Tilli G, Diaz-Corte Lugli drug A, M, Bagala A, Network-based Crespo Botta B, Borchi I, M, F. Bartiromo Beneyto 23. A, Cheng Alonso W, M, Cabello Martin J, Y, Alonso-Titos T, Huang Vazquez V, J, Lopez Shen 22. Y, Hou Y, Zhou 21. USFo rgAmnsrto.CrnvrsDsae21 (COVID-19) 2019 Disease Coronavirus coro- syndrome Administration. respiratory Drug acute Severe & PR. Food Hsueh HJ, U.S 9. Tang WC, Ko TP, Shih CC, Lai 8. CVD1)eiei:Wa r h ikfrssei ceoi ains.Atimnt Reviews. Autoimmunity patients?. sclerosis https://www.accessdata.fda.gov/drugsatfda systemic for risk https://doi.org/10.1016/j.autrev.2020.102558 the 5. 21. May are Apr 2020 What 2020 epidemic: Transplantation. (COVID-19) of Journal American Recipient. Transplant Kidney https://doi.org/10.1111/ajt.15936 and Heart https://doi.org/10.1111/ajt.15999 Dual 13. May 2020 Transplantation. of Journal American recipient. https://doi.org/10.1111/ajt.15928 plant 13. transplant Apr organ 2020 solid Transplantation. in of 2019 Journal disease American coronavirus recipients. of management immunosuppressant and racteristics 2020). 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May 18 (accessed oslbl21/07550llpf 00(cesd18 (accessed 2020 docs/label/2012/103795s5503lbl.pdf; oslbl20/64000b.d;22 acse 18 (accessed 2020 docs/label/2008/065410s000lbl.pdf; oslbl21/20309011s7llpf 2020 docs/label/2017/021083s059,021110s076lbl.pdf; 10 ® nrl(tnret,htt- (etanercept), Enbrel α niioscnincrease can inhibitors | FDA, Posted on Authorea 24 Sep 2020 — The copyright holder is the author/funder. All rights reserved. No reuse without permission. — https://doi.org/10.22541/au.160091464.40011130 — This a preprint and has not been peer reviewed. Data may be preliminary. otdfile Hosted Wli D oeto P utpeslrssadters fifcin osdrtosi h threat the in considerations infection: of repurpos- risk the drug and Network-based sclerosis EJ, Multiple F. Snijder NP. S, Robertson Makino Cheng MD, K, Narayanan Willis W, V, 40. Thiel Martin Y, Meer der Y, van JC, Huang Zevenhoven-Dobbe AH, Wilde J, de Shen 39. 2019 Y, se- Disease COronaVirus of Hou Novel (CRS) R. Y, Caporali syndrome Zhou F, release 38. Pignataro A, cytokine Minniti The G, Sambataro GQ. N, Wang Papa Del H, 37. Zhao JW, Li Z, Wu C, Zhang 36. Coron- Novel W. Liao With T, Bhutani Death SY, of Chan Risk BA, Higher Myers VD, at (rituximab), Reddy Patients of QG, Cancer Thibodeaux management Are ND, R. Brownstone and Kurzrock 35. care RF, Chemaly the RITUXAN J, Hajjar for JJ, Implication Adashek 34. Disease-2019: Coronavirus S. Manzi AH, Sawalha 33. in infection of risk the and pandemic threat COVID-19 Administration. NS. the Siddiqui in A, Waters considerations K, Murphy S, infection: Kelly S, of Mansoor risk Drug 32. the and sclerosis Multiple NP. 2020). May Robertson 18 & MD, (accessed Willis 2020 https://www.drugbank.ca/drugs/DB00073; 31. Rituximab, DrugBank.ca. Char- 30. N. Food Uriel G, Sayer S, Restaino Y, Naka U.S K, Takeda 29. MV, Habal KJ, EJ, Clerkin Snijder MA, S, Farr Makino F, K, Narayanan Latif V, 28. Thiel Y, Meer der van limit JC, to Zevenhoven-Dobbe time AH, it Wilde is de psoriasis: and 27. COVID-19 I. Zalaudek rheuma- N, and Meo Di disease-19 C, Coronavirus Dianzani A. R, Giuffrida Sharma C, GS, Conforti Naidu 26. V, Sharma D, Mishra A, Chattopadhyay 25. ftenvlcrnvrs OI-9SR-o-.Junlo erlg.22 a 1;267(5):1567-9. May 2020 Neurology. of Journal COVID-19/SARS-CoV-2. 16;6(1):1-8. https://doi.org/10.1007/s00415-020-09822-3 coronavirus, novel Mar the general of of 2020 Journal The https://doi.org/10.1099/vir.0.034983-0 coronaviruses. diverse 11):2542. of Nov;92(Pt replication discovery. the 2011 inhibits virology. A Cell Cyclosporin MJ. Hemert van 2019-nCoV/SARS-CoV-2. coronavirus 29:105954. 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The 2020 know?”. we Neurosurgery. 020-00177-0 do and bleep Psychiatry Neurology, the therapies:“what of modifying Journal disease on patients sclerosis 1;267(5):1567-9. multiple May 2020 Neurology. of Journal COVID-19/SARS-CoV-2. https://doi.org/10.1007/s00415-020-09822-3 coronavirus, novel the of 2020). May 18 cessed JAMA 2019. Disease https://www.accessdata.fda.gov/drugsatfda Coronavirus With Transplant https://doi.org/10.1001/jamacardio.2020.2159 Heart 13. of May 2020 Recipients cardiology. of Outcomes and general acteristics of Journal The https://doi.org/10.1099/vir.0.034983-0 coronaviruses. diverse 11):2542. of Nov;92(Pt replication the 2011 inhibits virology. A Cyclosporin 11:e13298. MJ. Hemert Mar van 2020 Therapy. Dermatologic action. for call https://doi.org/10.1111/dth.13298 A immunosuppressants? with treatment https://doi.org/10.4103/injr.injr review. narrative A disorders: tological 2020). May 18 (accessed https://www.accessdata.fda.gov/drugsatfda oslbl21/07556s38b.d;22 (ac- 2020 docs/label/2012/103705s5367s5388lbl.pdf; 2020 docs/label/2009/050715s027,050716s028lbl.pdf; 11 73 20 Posted on Authorea 24 Sep 2020 — The copyright holder is the author/funder. All rights reserved. No reuse without permission. — https://doi.org/10.22541/au.160091464.40011130 — This a preprint and has not been peer reviewed. Data may be preliminary. drugs-therapy-with-covid-19-associated-risks-drug-drug-interactions-contraindications Table.pdf file Hosted drugs-therapy-with-covid-19-associated-risks-drug-drug-interactions-contraindications Figures.pdf vial at available vial at available https://authorea.com/users/361397/articles/482791-immunosuppressant- https://authorea.com/users/361397/articles/482791-immunosuppressant- 12