Effects of immunosuppressive drugs on COVID-19 severity in patients with autoimmune hepatitis.

Abstract

BACKGROUND:

We investigated associations between baseline use of immunosuppressive drugs and severity of Coronavirus Disease 2019 (COVID-19) in autoimmune hepatitis (AIH).

PATIENTS AND METHODS:

Data of AIH patients with laboratory confirmed COVID-19 were retrospectively collected from 15 countries. The outcomes of AIH patients who were on immunosuppression at the time of COVID-19 were compared to patients who were not on AIH medication. The clinical courses of COVID-19 were classified as (i)-no hospitalization, (ii)-hospitalization without oxygen supplementation, (iii)-hospitalization with oxygen supplementation by nasal cannula or mask, (iv)-intensive care unit (ICU) admission with non-invasive mechanical ventilation, (v)-ICU admission with invasive mechanical ventilation or (vi)-death and analysed using ordinal logistic regression.

RESULTS:

We included 254 AIH patients (79.5%, female) with a median age of 50 (range, 17-85) years. At the onset of COVID-19, 234 patients (92.1%) were on treatment with glucocorticoids (n = 156), thiopurines (n = 151), mycophenolate mofetil (n = 22) or tacrolimus (n = 16), alone or in combinations. Overall, 94 (37%) patients were hospitalized and 18 (7.1%) patients died. Use of systemic glucocorticoids (adjusted odds ratio [aOR] 4.73, 95% CI 1.12-25.89) and thiopurines (aOR 4.78, 95% CI 1.33-23.50) for AIH was associated with worse COVID-19 severity, after adjusting for age-sex, comorbidities and presence of cirrhosis. Baseline treatment with mycophenolate mofetil (aOR 3.56, 95% CI 0.76-20.56) and tacrolimus (aOR 4.09, 95% CI 0.69-27.00) were also associated with more severe COVID-19 courses in a smaller subset of treated patients.

CONCLUSION:

Baseline treatment with systemic glucocorticoids or thiopurines prior to the onset of COVID-19 was significantly associated with COVID-19 severity in patients with AIH.

• Authors: Cumali Efe, Craig Lammert, Koray Taşçılar, Renumathy Dhanasekaran, Berat Ebik, Fatima Higuera-de la Tijera, Ali R Calışkan, Mirta Peralta, Alessio Gerussi, Hatef Massoumi, Andreea M Catana, Tugrul Purnak, Cristina Rigamonti, Andres J G Aldana, Nidah Khakoo, Leyla Nazal, Shalom Frager, Nurhan Demir, Kader Irak, Zeynep Melekoğlu-Ellik, Hüseyin Kacmaz, Yasemin Balaban, Kadri Atay, Fatih Eren, Mario R Alvares-da-Silva, Laura Cristoferi, Álvaro Urzua, Tuğçe Eşkazan, Bianca Magro, Romee Snijders, Sezgin Barutçu, Ellina Lytvyak, Godolfino M Zazueta, Aylin Demirezer-Bolat, Mesut Aydın, Alexandra Heurgue-Berlot, Eleonora De Martin, Nazım Ekin, Sümeyra Yıldırım, Ahmet Yavuz, Murat Bıyık, Graciela C Narro, Murat Kıyıcı, Murat Akyıldız, Evrim Kahramanoğlu-Aksoy, Maria Vincent, Rotonya M Carr, Fulya Günşar, Eira C Reyes, Murat Harputluoğlu, Costica Aloman, Nikolaos K Gatselis, Yücel Üstündağ, Javier Brahm, Nataly C E Vargas, Fatih Güzelbulut, Sandro R Garcia, Jonathan Aguirre, Margarita Anders, Natalia Ratusnu, Ibrahim Hatemi, Manuel Mendizabal, Annarosa Floreani, Stefano Fagiuoli, Marcelo Silva, Ramazan Idilman, Sanjaya K Satapathy, Marina Silveira, Joost P H Drenth, George N Dalekos, David N Assis, Einar Björnsson, James L Boyer, Eric M Yoshida, Pietro Invernizzi, Cynthia Levy, Aldo J Montano-Loza, Thomas D Schiano, Ezequiel Ridruejo, Staffan Wahlin
• Journal: Liver international : official journal of the International Association for the Study of the Liver (Liver Int) Vol. 42 Issue 3 Pg. 607-614 (03 2022) ISSN: 1478-3231 [Electronic] United States
• PMID: 34846800 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: © 2022 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Chemical References

• Pharmaceutical Preparations

Topics

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• COVID-19
• Female
• Hepatitis, Autoimmune (complications, drug therapy)
• Hospitalization
• Humans
• Male
• Middle Aged
• Pharmaceutical Preparations
• Retrospective Studies
• SARS-CoV-2
• Young Adult