DISCUSSION
Our study discusses the role of immunosuppressant drugs and susceptibility to SARS nCoV-2 virus along with its associated risk factors, adverse reactions, drug-drug interactions and contraindications. The study conducted by Brownstone ND, Thibodeaux QG, Reddy VD et. al., 2020 and Zhang C, Wu Z, Li JW et. al., 2020 shows Etanercept can cause serious COVID-19 infection risk for patients undergoing treatment for psoriasis leading to upper respiratory infection, influenza and serious infections. Moreover, patients who are older with comorbid conditions like lung disease, hypertension, diabetes, cancer or taking immunosuppressive drugs, etc. are also at serious risk of developing infection [35-36]. Another study by Del Papa N, Sambataro G, Minniti A, Pignataro F et. al., 2020 shows the role of mycophenolate mofetil’s in suppression of immune system of systemic sclerosis (SSc) leading to heightened vulnerability to develop COVID-19 with worse clinical outcomes. Chronic immunosuppressive therapies with SSc need to maintain precautions amid COVID-19 pandemic. It is associated with increased morbidity and mortality specially with underlying medical conditions like primary cardiomyopathy and secondary to pulmonary hypertension [37]. Zhou Y, Hou Y, Shen J, Huang Y et. al., 2020 shows that clinical application of Sirolimus reduces MERS (Middle East Respiratory Syndrome) CoV infection. It is also used to manage patients with acute respiratory failure and severe H1N1 pneumonia. The study also discusses the role of Sirolimus in autoimmune diseases including systemic lupus erythematosus, Crohn’s disease, rheumatoid arthritis, etc. [38]. de Wilde AH, Zevenhoven-Dobbe JC, van der Meer Y et. al., shows Cyclosporin’s effect on the replication of severe acute respiratory syndrome coronavirus (SARS-CoV). The study states that the mechanism of inhibition remains to be established. It reports that it is associated with one or multiple members of the cyclophilin family and it interferes with the functional interactions of viral proteins [39]. Another study by Willis MD, Robertson NP et. al., 2020 shows increased risk of infection among vulnerable cohort study populations suffering from multiple sclerosis. It also shows a serious risk of infection with Rituximab amid COVID-19 pandemic [40]. Overall, patients are advised to continue with their immunosuppressant medications unless they are asked by their respective healthcare provider to reduce the dosage or halt medication temporarily based upon the patient’s current condition and risk of contracting COVID-19.