COVID-19 and Immunomodulatory Therapy — Can We Use Data from Previous Viral Pandemics?
Bibliographic record
Abstract
The implications of COVID-19 are wide-ranging for specialties such as rheumatology in which immunomodulatory therapies are prescribed. There has been much trepidation among many healthcare professionals regarding the best course of management during this time. This pandemic has also left many national policy makers perplexed because of our limited knowledge of the effects of COVID-19 in patients with rheumatic disease. Such limitations have resulted in variable evolving guidance among rheumatologists around the globe. The British Society of Rheumatology (BSR) has recently published guidance to help stratify patients according to their level of risk and advise self-isolation or shielding measures for patients in high-risk groups1. Patients are advised to pause immunomodulation [except glucocorticoids (GC), hydroxychloroquine (HCQ), and sulfasalazine (SSZ)] if symptoms consistent with COVID-19 infection develop and to discuss re-initiation of therapy with their rheumatology team. The potential for the virus to persist subclinically in some individuals for an extended period of time after symptom resolution leaves a degree of apprehension among healthcare professionals regarding restarting therapy when an individual becomes asymptomatic. Other European societies, for example the Spanish Society of Rheumatology (SSR), similarly do not specify a time frame for restarting therapy, whereas the American College of Rheumatology (ACR) recommend re-initiation following a negative COVID-19 test or 2 weeks after symptom resolution2,3. The ACR, unlike the BSR, recommends temporary cessation of SSZ if infective symptoms develop, and also suggest cessation of nonsteroidal antiinflammatory drugs (NSAID), which differs from other international recommendations3. Although the SSR does not specify the continuation of HCQ, it notes that this, as well as other drugs [e.g., interleukin 6 (IL-6) or IL-1 and Janus kinase (JAK) inhibitors)] may be continued depending on local protocols2; similarly, the ACR suggests that IL-6 inhibitors may be continued in some … Address correspondence to Dr. H. Jethwa, Addenbrookes’ Hospital, Cambridge CB2 0QQ, UK. Email: hannahjethwa{at}nhs.net.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.034 | 0.175 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.005 | 0.003 |
| Bibliometrics | 0.008 | 0.007 |
| Science and technology studies | 0.002 | 0.004 |
| Scholarly communication | 0.011 | 0.029 |
| Open science | 0.005 | 0.007 |
| Research integrity | 0.009 | 0.016 |
| Insufficient payload (model declined to judge) | 0.019 | 0.007 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".