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

Cumali Efe, Craig Lammert, Koray Taşçılar, Renumathy Dhanasekaran, Berat Ebik, Fatima Higuera-de la Tijera, Ali R. Calışkan, Mirta Peralta, Alessio Gerussi, Hatef Massoumi, Andreea M. Catana, Tugrul Purnak, Cristina Rigamonti, Andres J.G. Aldana, Nidah Khakoo, Leyla Nazal, Shalom Frager, Nurhan Demir, Kader Irak, Zeynep Melekoğlu-EllikHüseyin Kacmaz, Yasemin Balaban, Kadri Atay, Fatih Eren, Mario R. Alvares-da-Silva, Laura Cristoferi, Álvaro Urzua, Tuğçe Eşkazan, Bianca Magro, Romee Snijders, Sezgin Barutçu, Ellina Lytvyak, Godolfino M. Zazueta, Aylin Demirezer-Bolat, Mesut Aydın, Alexandra Heurgue-Berlot, Eleonora De Martin, Nazım Ekin, Sümeyra Yıldırım, Ahmet Yavuz, Murat Bıyık, Graciela C. Narro, Murat Kıyıcı, Murat Akyıldız, Evrim Kahramanoğlu-Aksoy, Maria Vincent, Rotonya M. Carr, Fulya Günşar, Eira C. Reyes, Murat Harputluoğlu, Costica Aloman, Nikolaos K. Gatselis, Yücel Üstündağ, Javier Brahm, Nataly C.E. Vargas, Fatih Güzelbulut, Sandro R. Garcia, Jonathan Aguirre, Margarita Anders, Natalia Ratusnu, Ibrahim Hatemi, Manuel Mendizabal, Annarosa Floreani, Stefano Fagiuoli, Marcelo Silva, Ramazan Idilman, Sanjaya K. Satapathy, Marina Silveira, Joost P.H. Drenth, George N. Dalekos, David N.Assis, Einar Björnsson, James L. Boyer, Eric M. Yoshida, Pietro Invernizzi, Cynthia Levy, Aldo J. Montano-Loza, Thomas D. Schiano, Ezequiel Ridruejo, Staffan Wahlin

Research output: Contribution to journalArticlepeer-review

4 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)607-614
Number of pages8
JournalLiver International
Volume42
Issue number3
DOIs
StatePublished - Mar 2022
Externally publishedYes

Keywords

  • SARS-CoV-2
  • autoimmunity
  • azathioprine
  • budesonide
  • liver transplantation
  • mercaptopurine

ASJC Scopus subject areas

  • Hepatology

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