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

Efe C.; Lammert C.; Taşçılar K.; Dhanasekaran R.; Ebik B.; Higuera-de la Tijera F.; Calışkan A.R.; Peralta M.; Gerussi A.; Massoumi H.; Catana A.M.; Purnak T.; Rigamonti C.; Aldana A.J.G.; Khakoo N.; Nazal L.; Frager S.; Demir N.; Irak K.; Melekoğlu-Ellik Z.; Kacmaz H.; Balaban Y.; Atay K.; Eren F.; Alvares-da-Silva M.R.; Cristoferi L.; Urzua Á.; Eşkazan T.; Magro B.; Snijders R.; Barutçu S.; Lytvyak E.; Zazueta G.M.; Demirezer-Bolat A.; Aydın M.; Heurgue-Berlot A.; De Martin E.; Ekin N.; Yıldırım S.; Yavuz A.; Bıyık M.; Narro G.C.; Kıyıcı M.; Akyıldız M.; Kahramanoğlu-Aksoy E.; Vincent M.; Carr R.M.; Günşar F.; Reyes E.C.; Harputluoğlu M.; Aloman C.; Gatselis N.K.; Üstündağ Y.; Brahm J.; Vargas N.C.E.; Güzelbulut F.; Garcia S.R.; Aguirre J.; Anders M.; Ratusnu N.; Hatemi I.; Mendizabal M.; Floreani A.; Fagiuoli S.; Silva M.; Idilman R.; Satapathy S.K.; Silveira M.; Drenth J.P.H.; Dalekos G.N.; N.Assis D.; Björnsson E.; Boyer J.L.; Yoshida E.M.; Invernizzi P.; Levy C.; Montano-Loza A.J.; Schiano T.D.; Ridruejo E.; Wahlin S. · Liver International (2022) · DOI: 10.1111/liv.15121

Resumen

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.