Impact of COVID-19 pandemic on management of autoimmune and inflammatory diseases in Morocco

According to the World Health Organizations' (WHO) data, in globally, in 19th September 2020, there have been 30,369,778 confirmed cases of COVID-19, including 948,795 deaths [2]. Table 1 practical recommendations for management of autoimmune or inflammatory diseases during COVID-19 pandemic Hygiene procedures management of all autoimmune or inflammatory disease Patients should be counselled on general preventive measures, e.g. social distancing, hand hygiene, wearing masks in public places Reduce the frequency of routine laboratory surveillance when the associated risk of not testing is deemed to be low. Optimal use of tele-health Patients should have their vaccination against influenza and pneumococcal updated Anti-malarials such as HCQ and CQ do not protect against SARS-CoV-2 and as such, patients on HCQ or CQ for AI/ID should be advised to observe necessary precautions to prevent infection Where possible, the use of subcutaneous formulations of bDMARDs and bsDMARDs should be considered instead of IV infusions to limit patients' attendance to the hospital Continued use of ACE inhibitors and ARBs per standard of care in rheumatic disease (patient with a history or risk of scleroderma renal crisis or those with SLE and hypertension) Possibility to potential temporary delays in performing intravenous administration of zoledronic acid or subcutaneous administration of denosumab: dosing intervals with denosumab not exceed 8 months due to concerns regarding increased vertebral fracture risk following denosumab withdrawal Drugs for All autoimmune or inflammatory disease Glucocorticoids should be used at the lowest dose possible to control rheumatic disease, regardless of exposure or infection status Glucocorticoids should not be abruptly stopped, regardless of exposure or infection status HCQ/CQ, SSZ, MTX, LEF, immune-suppressants (e.g. tacrolimus, CSA, MMF, AZA), biologics (TNF or IL- 6 receptor inhibitors), JAK inhibitors and NSAIDs may be continued In the context of a drug shortage due to COVID-19, new HCQ/CQ prescriptions for non-approved indications should be avoided ACE inhibitors or ARBs should be continued in full doses or initiated Systemic lupus erythematosus patients Newly diagnosed disease: Immuno-suppressants (e.g. tacrolimus, CSA, MMF, AZA), non-IL-6 biologics, and JAK inhibitors should be stopped temporarily, pending a negative test result for COVID-19 or after 2 weeks of symptom-free observation Re-iniating treatment following COVID-19 Decision