Effects of immunosuppressive drugs on COVID-19 severity in patients with autoimmune hepatitis.
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Efe Cumali, Lammert Craig, Taşçılar Koray, Dhanasekaran Renumathy, Ebik Berat, Higuera-de la Tijera Fatima, Calışkan Ali R, Peralta Mirta, Gerussi Alessio, Massoumi Hatef, Catana Andreea M, Purnak Tugrul, Rigamonti Cristina, Aldana Andres J G, Khakoo Nidah, Nazal Leyla, Frager Shalom, Demir Nurhan, Irak Kader, Melekoğlu-Ellik Zeynep, Kacmaz Hüseyin, Balaban Yasemin, Atay Kadri, Eren Fatih, Alvares-da-Silva Mario R, Cristoferi Laura, Urzua Álvaro, Eşkazan Tuğçe, Magro Bianca, Snijders Romee, Barutçu Sezgin, Lytvyak Ellina, Zazueta Godolfino M, Demirezer-Bolat Aylin, Aydın Mesut, Heurgue-Berlot Alexandra, De Martin Eleonora, Ekin Nazım, Yıldırım Sümeyra, Yavuz Ahmet, Bıyık Murat, Narro Graciela C, Kıyıcı Murat, Akyıldız Murat, Kahramanoğlu-Aksoy Evrim, Vincent Maria, Carr Rotonya M, Günşar Fulya, Reyes Eira C, Harputluoğlu Murat, Aloman Costica, Gatselis Nikolaos K, Üstündağ Yücel, Brahm Javier, Vargas Nataly C E, Güzelbulut Fatih, Garcia Sandro R, Aguirre Jonathan, Anders Margarita, Ratusnu Natalia, Hatemi Ibrahim, Mendizabal Manuel, Floreani Annarosa, Fagiuoli Stefano, Silva Marcelo, Idilman Ramazan, Satapathy Sanjaya K, Silveira Marina, Drenth Joost P H, Dalekos George N, N Assis David, Björnsson Einar, Boyer James L, Yoshida Eric M, Invernizzi Pietro, Levy Cynthia, Montano-Loza Aldo J, Schiano Thomas D, Ridruejo Ezequiel, Wahlin Staffan
Аннотация
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.