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.

Efe, C., Lammert, C., Tascilar, K., Dhanasekaran, R., Ebik, B., Higuera-de la Tijera, F., et al. (2022). Effects of immunosuppressive drugs on COVID-19 severity in patients with autoimmune hepatitis. LIVER INTERNATIONAL, 42(3), 607-614 [10.1111/liv.15121].

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

Gerussi, A;Cristoferi, L;Fagiuoli, S;
2022

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.
Articolo in rivista - Articolo scientifico
autoimmunity; azathioprine; budesonide; liver transplantation; mercaptopurine; SARS-CoV-2;
English
607
614
8
Efe, C., Lammert, C., Tascilar, K., Dhanasekaran, R., Ebik, B., Higuera-de la Tijera, F., et al. (2022). Effects of immunosuppressive drugs on COVID-19 severity in patients with autoimmune hepatitis. LIVER INTERNATIONAL, 42(3), 607-614 [10.1111/liv.15121].
Efe, C; Lammert, C; Tascilar, K; Dhanasekaran, R; Ebik, B; Higuera-de la Tijera, F; Caliskan, A; Peralta, M; Gerussi, A; Massoumi, H; Catana, A; Purnak, T; Rigamonti, C; Aldana, A; Khakoo, N; Nazal, L; Frager, S; Demir, N; Irak, K; Melekoglu-Ellik, Z; Kacmaz, H; Balaban, Y; Atay, K; Eren, F; Alvares-da-Silva, M; Cristoferi, L; Urzua, A; Eskazan, T; Magro, B; Snijders, R; Barutcu, S; Lytvyak, E; Zazueta, G; Demirezer-Bolat, A; Aydin, M; Heurgue-Berlot, A; De Martin, E; Ekin, N; Yildirim, S; Yavuz, A; Biyik, M; Narro, G; Kiyici, M; Akyildiz, M; Kahramanoglu-Aksoy, E; Vincent, M; Carr, R; Gunsar, F; Reyes, E; Harputluoglu, M; Aloman, C; Gatselis, N; Ustundag, Y; Brahm, J; Vargas, N; Guzelbulut, F; Garcia, S; Aguirre, J; Anders, M; Ratusnu, N; Hatemi, I; Mendizabal, M; Floreani, A; Fagiuoli, S; Silva, M; Idilman, R; Satapathy, S; Silveira, M; Drenth, J; Dalekos, G; Assis, D; Bjornsson, E; Boyer, J; Yoshida, E; Invernizzi, P; Levy, C; Montano-Loza, A; Schiano, T; Ridruejo, E; Wahlin, S
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/10281/388337
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