“Immunosuppressed and stuck at home?”
My husband was recently diagnosed with lupus. He is on hydroxychloroquine and CellCept which I understand makes him more vulnerable to infections including covid. We have remained in isolation at home since the very beginning of the pandemic. We have two elementary-aged children who have been attending virtual classes. We both work from home. We are both vaccinated. The children are too young to be vaccinated. It is time to make a decision about school next year for the kids. My husband wants to keep them home again. This makes working nearly impossible. How vulnerable is my husband? I believe my kids need to go back to school, but he is very afraid to do so and worried about the severe consequences if he catches Covid from them. How important to my husband’s health is it that we keep the kids home? They have not seen friends and extended family in over a year. Thank you.
Male | 46 years old
Medications: Hydroxychloroquine, cellcept
Conditions: Lupus
4 Answers
With the vaccinations, you should send the kids to school. Cellcept shouldn't hold that back. First, hydroxychloroquine or Plaquenil, is no reason to worry. It doesn't increase infection risk much at all. The "bigger med", Cellcept functions more to reduce B-cell antibody production (so blocking antibodies associated with AUTO-immunity in lupus). Antibodies are important and the only thing you hear about, but in reality the T cells are the real virus killers not the antibodies themselves- these T cells with "memory" should be present in your husband and still function. This is especially for viruses given they rely on human cells (they are inside the cell usually), which require T cells and Cellcept shouldn't bring that ability down against viral infections. An example, I had a public school teacher or max dose of cellcept, and she was just fine despite being showered constantly in viral particles (I assume with so many kids around). So, nothing to worry about and the kids need their elementary schooling.
Thank you for reaching out to us. Since your husband is not an established patient with us, we can not give any medical advice. It is recommended that you reach out to his current rheumatologist who is treating his lupus. Thank you
Moderate, Cellcept is immunosuppressive, plaquenil is NOT. Consider having COVID 19 antibody levels assessed. If low, COVID antibody infusions will be helpful for prevention, minimizing the severity of COVID infection. Paxlovid treatment is an option if he contract COVID infection if treated early.
Dr. Tamar Brionez
Houston, TX
Hello!
Thank you for your question. Although we know that immunosuppressive medications and lupus increase risk of infection, the benefit vs. risk ratio for your family of getting back into the world is a personal decision that each family unit has to make on their own. It is recommended to receive the vaccine, which you and your husband have done. Studies are ongoing for vaccines in our pediatric population and will hopefully be done by end of summer/start of school year. Your question is a tough one with no easy answer.
I wish you the best of luck!
Best regards,
Dr. Brionez
Thank you for your question. Although we know that immunosuppressive medications and lupus increase risk of infection, the benefit vs. risk ratio for your family of getting back into the world is a personal decision that each family unit has to make on their own. It is recommended to receive the vaccine, which you and your husband have done. Studies are ongoing for vaccines in our pediatric population and will hopefully be done by end of summer/start of school year. Your question is a tough one with no easy answer.
I wish you the best of luck!
Best regards,
Dr. Brionez
