1. Effects of immunosuppressive drugs on COVID-19 severity in patients with autoimmune hepatitis
- Author
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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. Gomez, 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.J.A.L.M., Barutçu, S., Lytvyak, E., Zazueta, G.M., Demirezer-Bolat, A., Aydın, M., Heurgue-Berlot, A., 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., Assis, D.N., Björnsson, E., Boyer, J.L., Yoshida, E.M., Invernizzi, P., Levy, C., Montano-Loza, A.J., Schiano, T.D., Ridruejo, E., Wahlin, S., 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. Gomez, 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.J.A.L.M., Barutçu, S., Lytvyak, E., Zazueta, G.M., Demirezer-Bolat, A., Aydın, M., Heurgue-Berlot, A., 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., Assis, D.N., Björnsson, E., Boyer, J.L., Yoshida, E.M., Invernizzi, P., Levy, C., Montano-Loza, A.J., Schiano, T.D., Ridruejo, E., and Wahlin, S.
- Abstract
Item does not contain fulltext, 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.
- Published
- 2022