tetano
Editor, Senior Moderator
Liver Int
. 2021 Nov 30.
doi: 10.1111/liv.15121. Online ahead of print.
Effects of Immunosuppressive Drugs on COVID-19 severity in Patients with Autoimmune Hepatitis
Cumali Efe[SUP] 1 [/SUP], Craig Lammert[SUP] 2 [/SUP], Koray Taşçılar[SUP] 3 [/SUP], Renumathy Dhanasekaran[SUP] 4 [/SUP], Berat Ebik[SUP] 5 [/SUP], Fatima Higuera-de la Tijera[SUP] 6 [/SUP], Ali Rıza Calışkan[SUP] 7 [/SUP], Mirta Peralta[SUP] 8 9 [/SUP], Alessio Gerussi[SUP] 10 11 [/SUP], Hatef Massoumi[SUP] 12 [/SUP], Andreea M Catana[SUP] 13 [/SUP], Tugrul Purnak[SUP] 14 [/SUP], Cristina Rigamonti[SUP] 15 [/SUP], Andres Jose Gomez Aldana[SUP] 16 [/SUP], Nidah Khakoo[SUP] 17 [/SUP], Leyla Nazal[SUP] 18 [/SUP], Shalom Frager[SUP] 12 [/SUP], Nurhan Demir[SUP] 19 [/SUP], Kader Irak[SUP] 20 [/SUP], Zeynep Melekoğlu Ellik[SUP] 21 [/SUP], Hüseyin Kacmaz[SUP] 7 [/SUP], Yasemin Balaban[SUP] 22 [/SUP], Kadri Atay[SUP] 23 [/SUP], Fatih Eren[SUP] 24 [/SUP], Mario Reis Alvares-da-Silva[SUP] 25 [/SUP], Laura Cristoferi[SUP] 10 11 [/SUP], Álvaro Urzua[SUP] 26 [/SUP], Tuğçe Eşkazan[SUP] 27 [/SUP], Bianca Magro[SUP] 28 [/SUP], Romee Snijders[SUP] 29 30 [/SUP], Sezgin Barutçu[SUP] 31 [/SUP], Ellina Lytvyak[SUP] 32 [/SUP], Godolfino Miranda Zazueta[SUP] 33 [/SUP], Aylin Demirezer Bolat[SUP] 34 [/SUP], Mesut Aydın[SUP] 35 [/SUP], Alexandra Heurgue-Berlot[SUP] 36 [/SUP], Eleonora De Martin[SUP] 37 [/SUP], Nazım Ekin[SUP] 5 [/SUP], Sümeyra Yıldırım[SUP] 38 [/SUP], Ahmet Yavuz[SUP] 39 [/SUP], Murat Bıyık[SUP] 39 [/SUP], Graciela Castro Narro[SUP] 33 [/SUP], Murat Kıyıcı[SUP] 40 [/SUP], Murat Akyıldız[SUP] 41 [/SUP], Evrim Kahramanoğlu-Aksoy[SUP] 42 [/SUP], Maria Vincent[SUP] 43 [/SUP], Rotonya M Carr[SUP] 44 [/SUP], Fulya Günşar[SUP] 45 [/SUP], Eira Cerda Reyes[SUP] 46 [/SUP], Murat Harputoğlu[SUP] 47 [/SUP], Costica Aloman[SUP] 48 [/SUP], Nikolaos K Gatselis[SUP] 49 [/SUP], Yücel Üstündağ[SUP] 50 [/SUP], Javier Brahm[SUP] 51 [/SUP], Nataly Chris Escajadillo Vargas[SUP] 52 [/SUP], Fatih Güzelbulut[SUP] 53 [/SUP], Sandro Ruiz Garcia[SUP] 54 [/SUP], Jonathan Aguirre[SUP] 55 [/SUP], Margarita Anders[SUP] 56 [/SUP], Natalia Ratusnu[SUP] 57 [/SUP], Ibrahim Hatemi[SUP] 27 [/SUP], Manuel Mendizabal[SUP] 9 58 [/SUP], Annarosa Floreani[SUP] 59 60 [/SUP], Stefano Fagiuoli[SUP] 28 [/SUP], Marcelo Silva[SUP] 9 58 [/SUP], Ramazan Idilman[SUP] 21 [/SUP], Sanjaya K Satapathy[SUP] 43 [/SUP], Marina Silveira[SUP] 61 [/SUP], Joost P H Drenth[SUP] 29 30 [/SUP], George N Dalekos[SUP] 49 [/SUP], David N Assis[SUP] 61 [/SUP], Einar Björnsson[SUP] 62 [/SUP], James L Boyer[SUP] 61 [/SUP], Eric M Yoshida[SUP] 63 [/SUP], Pietro Invernizzi[SUP] 10 11 [/SUP], Cynthia Levy[SUP] 17 [/SUP], Aldo J Montano-Loza[SUP] 32 [/SUP], Thomas D Schiano[SUP] 64 [/SUP], Ezequiel Ridruejo[SUP] 9 58 65 [/SUP], Staffan Wahlin[SUP] 66 [/SUP]
Affiliations
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 was 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 analyzed 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.
Keywords: Liver transplantation; SARS-CoV-2; autoimmunity; azathioprine; budesonide; mercaptopurine.
. 2021 Nov 30.
doi: 10.1111/liv.15121. Online ahead of print.
Effects of Immunosuppressive Drugs on COVID-19 severity in Patients with Autoimmune Hepatitis
Cumali Efe[SUP] 1 [/SUP], Craig Lammert[SUP] 2 [/SUP], Koray Taşçılar[SUP] 3 [/SUP], Renumathy Dhanasekaran[SUP] 4 [/SUP], Berat Ebik[SUP] 5 [/SUP], Fatima Higuera-de la Tijera[SUP] 6 [/SUP], Ali Rıza Calışkan[SUP] 7 [/SUP], Mirta Peralta[SUP] 8 9 [/SUP], Alessio Gerussi[SUP] 10 11 [/SUP], Hatef Massoumi[SUP] 12 [/SUP], Andreea M Catana[SUP] 13 [/SUP], Tugrul Purnak[SUP] 14 [/SUP], Cristina Rigamonti[SUP] 15 [/SUP], Andres Jose Gomez Aldana[SUP] 16 [/SUP], Nidah Khakoo[SUP] 17 [/SUP], Leyla Nazal[SUP] 18 [/SUP], Shalom Frager[SUP] 12 [/SUP], Nurhan Demir[SUP] 19 [/SUP], Kader Irak[SUP] 20 [/SUP], Zeynep Melekoğlu Ellik[SUP] 21 [/SUP], Hüseyin Kacmaz[SUP] 7 [/SUP], Yasemin Balaban[SUP] 22 [/SUP], Kadri Atay[SUP] 23 [/SUP], Fatih Eren[SUP] 24 [/SUP], Mario Reis Alvares-da-Silva[SUP] 25 [/SUP], Laura Cristoferi[SUP] 10 11 [/SUP], Álvaro Urzua[SUP] 26 [/SUP], Tuğçe Eşkazan[SUP] 27 [/SUP], Bianca Magro[SUP] 28 [/SUP], Romee Snijders[SUP] 29 30 [/SUP], Sezgin Barutçu[SUP] 31 [/SUP], Ellina Lytvyak[SUP] 32 [/SUP], Godolfino Miranda Zazueta[SUP] 33 [/SUP], Aylin Demirezer Bolat[SUP] 34 [/SUP], Mesut Aydın[SUP] 35 [/SUP], Alexandra Heurgue-Berlot[SUP] 36 [/SUP], Eleonora De Martin[SUP] 37 [/SUP], Nazım Ekin[SUP] 5 [/SUP], Sümeyra Yıldırım[SUP] 38 [/SUP], Ahmet Yavuz[SUP] 39 [/SUP], Murat Bıyık[SUP] 39 [/SUP], Graciela Castro Narro[SUP] 33 [/SUP], Murat Kıyıcı[SUP] 40 [/SUP], Murat Akyıldız[SUP] 41 [/SUP], Evrim Kahramanoğlu-Aksoy[SUP] 42 [/SUP], Maria Vincent[SUP] 43 [/SUP], Rotonya M Carr[SUP] 44 [/SUP], Fulya Günşar[SUP] 45 [/SUP], Eira Cerda Reyes[SUP] 46 [/SUP], Murat Harputoğlu[SUP] 47 [/SUP], Costica Aloman[SUP] 48 [/SUP], Nikolaos K Gatselis[SUP] 49 [/SUP], Yücel Üstündağ[SUP] 50 [/SUP], Javier Brahm[SUP] 51 [/SUP], Nataly Chris Escajadillo Vargas[SUP] 52 [/SUP], Fatih Güzelbulut[SUP] 53 [/SUP], Sandro Ruiz Garcia[SUP] 54 [/SUP], Jonathan Aguirre[SUP] 55 [/SUP], Margarita Anders[SUP] 56 [/SUP], Natalia Ratusnu[SUP] 57 [/SUP], Ibrahim Hatemi[SUP] 27 [/SUP], Manuel Mendizabal[SUP] 9 58 [/SUP], Annarosa Floreani[SUP] 59 60 [/SUP], Stefano Fagiuoli[SUP] 28 [/SUP], Marcelo Silva[SUP] 9 58 [/SUP], Ramazan Idilman[SUP] 21 [/SUP], Sanjaya K Satapathy[SUP] 43 [/SUP], Marina Silveira[SUP] 61 [/SUP], Joost P H Drenth[SUP] 29 30 [/SUP], George N Dalekos[SUP] 49 [/SUP], David N Assis[SUP] 61 [/SUP], Einar Björnsson[SUP] 62 [/SUP], James L Boyer[SUP] 61 [/SUP], Eric M Yoshida[SUP] 63 [/SUP], Pietro Invernizzi[SUP] 10 11 [/SUP], Cynthia Levy[SUP] 17 [/SUP], Aldo J Montano-Loza[SUP] 32 [/SUP], Thomas D Schiano[SUP] 64 [/SUP], Ezequiel Ridruejo[SUP] 9 58 65 [/SUP], Staffan Wahlin[SUP] 66 [/SUP]
Affiliations
- PMID: 34846800
- 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 was 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 analyzed 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.
Keywords: Liver transplantation; SARS-CoV-2; autoimmunity; azathioprine; budesonide; mercaptopurine.