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

Efe C, Lammert C, Tascilar K, Dhanasekaran R, Ebik B, Higuera-De La Tijera F, Caliskan AR, Peralta M, Gerussi A, Massoumi H, Catana AM, Purnak T, Rigamonti C, Aldana AJG, Khakoo N, Nazal L, Frager S, Demir N, Irak K, Melekoglu-Ellik Z, Kacmaz H, Balaban Y, Atay K, Eren F, Alvares-Da-Silva MR, Cristoferi L, Urzua A, Eskazan T, Magro B, Snijders R, Barutcu S, Lytvyak E, Zazueta GM, Demirezer-Bolat A, Aydin M, Heurgue-Berlot A, De Martin E, Ekin N, Yildirim S, Yavuz A, Biyik M, Narro GC, Kiyici M, Akyildiz M, Kahramanoglu-Aksoy E, Vincent M, Carr RM, Gunsar F, Reyes EC, Harputluoglu M, Aloman C, Gatselis NK, Ustundag Y, Brahm J, Vargas NCE, Guzelbulut F, Garcia SR, Aguirre J, Anders M, Ratusnu N, Hatemi I, Mendizabal M, Floreani A, Fagiuoli S, Silva M, Idilman R, Satapathy SK, Silveira M, Drenth JPH, Dalekos GN, Assis DN, Bjornsson E, Boyer JL, Yoshida EM, Invernizzi P, Levy C, Montano-Loza AJ, Schiano TD, Ridruejo E, Wahlin S (2021)

Publication Type: Journal article

Publication year: 2021

Journal

DOI: 10.1111/liv.15121

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 with CRIS profile

Involved external institutions

Hospital General de México Mexico (MX) University of Milano-Bicocca / Università degli Studi di Milano-Bicocca, UNIMIB Italy (IT) Montefiore Medical Center United States (USA) (US) Harran Üniversitesi Turkey (TR) Indiana University – Purdue University Indianapolis United States (USA) (US) Diyarbakir Gazi Yasargil Education and Research Hospital Turkey (TR) Adıyaman Üniversitesi Turkey (TR) Hospital Muñiz / Hospital de Infecciosas Francisco Javier Muñiz Argentina (AR) Universidad de Santiago de Chile (USACH) / University of Santiago, Chile Chile (CL) Istanbul University Cerrahpaşa / İstanbul Üniversitesi Cerrahpaşa (IUC) Turkey (TR) Radboud University Nijmegen Medical Centre / Radboudumc of voluit Radboud Universitair Medisch Centrum (UMC) Netherlands (NL) Gaziantep University / Gaziantep Üniversitesi Turkey (TR) Erciyes University / Erciyes Üniversitesi Turkey (TR) Haydarpasa Numune Research and Teaching Hospital Turkey (TR) Hospital Victor Lazarte Echegaray Peru (PE) Hospital Angeles Pedregal Mexico (MX) University of Miami United States (USA) (US) University of Alberta Canada (CA) Mount Sinai Hospital United States (USA) (US) Hospital Universitario Austral Argentina (AR) Karolinska Institute Sweden (SE) Stanford University United States (USA) (US) Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán Mexico (MX) Uludag University / Uludağ Üniversitesi Turkey (TR) Koç-Universität (KU) Turkey (TR) Kecioren Research and Training Hospital Turkey (TR) Northwell Health United States (USA) (US) University of Pennsylvania United States (USA) (US) Ege University / Ege Üniversitesi Turkey (TR) Hospital Central Militar Mexico / Central Military Hospital Mexico (MX) İnönü University Turkey (TR) Rush University United States (USA) (US) General University Hospital of Larissa Greece (GR) Bülent Ecevit University / Bülent Ecevit Üniversitesi Turkey (TR) Clínica Las Condes Chile (CL) Hospital Nacional Almanzor Aguinaga Asenjo Peru (PE) ASST Papa Giovanni XXIII Italy (IT) Ankara University / Ankara Üniversitesi Turkey (TR) Yale University United States (USA) (US) University of British Columbia Canada (CA) Harvard University United States (USA) (US) McGovern Medical School United States (USA) (US) Hacettepe University Turkey (TR) Ankara City Hospital / Ankara Şehir Hastanesi Turkey (TR) Yüzüncü Yıl University Turkey (TR) Centre hospitalier universitaire de Reims (CHU de Reims) France (FR) École Polytechnique - Université Paris-Saclay France (FR) University of Eastern Piedmont / Università degli Studi del Piemonte Orientale "Amedeo Avogadro" Italy (IT) Hospital Universitário Fundación Santa Fe de Bogotá Colombia (CO) İstanbul Haseki Training and Research Hospital Turkey (TR) Kanuni Sultan Suleyman Training and Research Hospital Turkey (TR) Mardin State Hospital Turkey (TR) Ordu State Hospital Turkey (TR) Hospital de Clínicas de Porto Alegre (HCPA) Brazil (BR) Necmettin Erbakan Üniversitesi Turkey (TR) Hospital Alemán Argentina (AR) Hospital Regional Ushuaia Gobernador Ernesto Campos Argentina (AR) Ospedale Sacro Cuore Don Calabria Italy (IT) Landspítali / National University Hospital of Iceland Iceland (IS)

How to cite

APA:

Efe, C., Lammert, C., Tascilar, K., Dhanasekaran, R., Ebik, B., Higuera-De La Tijera, F.,... Wahlin, S. (2021). Effects of immunosuppressive drugs on COVID-19 severity in patients with autoimmune hepatitis. Liver International. https://doi.org/10.1111/liv.15121

MLA:

Efe, Cumali, et al. "Effects of immunosuppressive drugs on COVID-19 severity in patients with autoimmune hepatitis." Liver International (2021).

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