ACR Guidelines For Infusions During COVID-19

New guidelines from the American College of Rheumatology (ACR) recommend ways to manage infusion services during the COVID-19 pandemic. They also explain what doctors must consider when deciding to give biologic infusions to each individual.¹

Many people with rheumatic diseases have concerns about the safety of in-office therapy right now. These guidelines can help ease these concerns by protecting people coming in for infusions.

If you are scheduled for an in-office infusion, you may want to confirm with your doctor that these guidelines are being followed. Your doctor can also discuss safety considerations for your specific case. No one should discontinue medication without talking to their doctor.

Considerations for continuing infusions

The decision to continue infusions depends on each person’s situation. It must be made in consultation with a doctor. Some factors that must be considered are:

Impact of infusion on COVID-19 infection

Biologic infusions usually reduce inflammation by suppressing the immune system. We do not know how specific infusions affect COVID-19 infection. But a weaker immune system makes people vulnerable to infections of any kind. How the specific infusion affects the immune system is one factor that doctors must consider.

Impact of changing or stopping infusions on symptoms

Biologic infusions are used to treat lupus, rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, and other diseases. They treat disease symptoms and prevent long-term joint damage. Stopping infusions can lead to flares, inflammatory bowel disease, or psoriasis.² But postponing for one or two weeks may pose less of a risk. Weighing this risk must be done on a case-by-case basis.

Access to treatment

Biologic infusions are administered intravenously, usually at a doctor’s office or hospital. The risks involved in traveling to an office or hospital must be considered. There may also be difficulties for people to travel right now. In these scenarios, alternate ways to find treatment should be discussed.¹

What are the ACR guidelines for biologic infusions?

ACR recommends that facilities managing infusion therapy should do the following:¹

• Sanitize all facilities often with a disinfectant effective against COVID-19. Ensure the surface is wet for the full contact time.
• Disinfect equipment and surfaces in care areas between each use. Also pay special attention to surfaces in check-in areas.
• Communicate social distancing and hygiene procedures. Place waiting room chairs at least six feet apart. Consider asking people to wait for their appointment outside in their vehicles. Ensure that hand sanitizer is available in care areas.
• Screen everyone for symptoms of COVID-19 before they enter the facility.

CDC guidelines for healthcare facilities

These guidelines follow the recommendations of the CDC (Centers for Disease Control and Prevention). Here are some key steps that healthcare facilities can take, according to the CDC:^3,4

• Limit how germs can enter the facility. Use telemedicine, limit points of entry, manage visitors, and screen everyone for respiratory symptoms.
• Isolate people showing symptoms of infection as soon as possible. Set up separate areas for people with suspected COVID-19.
• Protect healthcare workers. Emphasize hand hygiene, limit the number of staff providing care to people with COVID-19, and encourage sick employees to stay home.

Talk to your doctor about potential solutions or alternatives

You and your doctor may decide that the risks of in-office infusions outweigh the benefits. Possible temporary changes to treatment may include pausing therapy, using a less potent treatment, or trying an alternative therapy. This decision must be individualized.¹

And there may be rare situations where infusions must be done at home. This could occur if the facility is unable to offer in-office therapies. Or it could happen if you or someone in your household shows symptoms of COVID-19. In these cases, a self-injectable version of the medication may be prescribed.²

If you and your doctor decide to continue in-office infusions, take steps to protect yourself. Call the healthcare facility to confirm they are following these guidelines. And follow national guidelines for hygiene and social distancing practices.