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

• Autores: Efe, Cumali; Lammert, Craig; Taşçılar, Koray; Dhanasekaran, Renumathy; Ebik, Berat; Higuera de la Tijera, Fatima; Calışkan, Ali R.; Peralta, Mirta; Gerussi, Alessio; Massoumi, Hatef; Catana, Andreea M.; Purnak, Tugrul; Rigamonti, Cristina; Aldana, Andres J. G.; Khakoo, Nidah; Nazal, Leyla; Frager, Shalom; Demir, Nurhan; Irak, Kader; Melekoğlu Ellik, Zeynep; Kacmaz, Hüseyin; Balaban, Yasemin; Atay, Kadri; Eren, Fatih; Alvares da-Silva, Mario R.; Cristoferi, Laura; Urzua, Álvaro; Eşkazan, Tuğçe; Magro, Bianca; Snijders, Romee; Barutçu, Sezgin; Lytvyak, Ellina; Zazueta, Godolfino M.; Demirezer Bolat, Aylin; Aydın, Mesut; Amorós Martín, Alexandra Noemí; De Martin, Eleonora; Ekin, Nazım; Yıldırım, Sümeyra; Yavuz, Ahmet; Bıyık, Murat; Narro, Graciela C.; Bıyık, Murat; Kıyıcı, Murat; Kahramanoğlu Aksoy, Evrim; Vincent, Maria; Carr, Rotonya M.; Günşar, Fulya; Reyes, Eira C.; Harputluoğlu, Murat; Aloman, Costica; Gatselis, Nikolaos K.; Üstündağ, Yücel; Brahm, Javier; Vargas, Nataly C. E.; Güzelbulut, Fatih; Garcia, Sandro R.; Aguirre, Jonathan; Anders, Margarita; Ratusnu, Natalia; Hatemi, Ibrahim; Mendizabal, Manuel; Floreani, Annarosa; Fagiuoli, Stefano; Silva, Marcelo; Idilman, Ramazan; Satapathy, Sanjaya K.; Silveira, Marina; Drenth, Joost P. H.; Dalekos, George N.; N.Assis, David; Björnsson, Einar; Boyer, James L.; Yoshida, Eric M.; Invernizzi, Pietro; Levy, Cynthia; Montano Loza, Aldo J.; Schiano, Thomas D.; Ridruejo, Ezequiel; Wahlin, Staffan
• Año de publicación: 2021
• Idioma: inglés
• Tipo de recurso: artículo
• Materia: AUTOIMMUNITY; AZATHIOPRINE; BUDESONIDE; LIVER TRANSPLANTATION; MERCAPTOPURINE; SARS-COV-2; COVID-19
• Institución: Consejo Nacional de Investigaciones Científicas y Técnicas

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.
Fil: Efe, Cumali. Harran University Hospita; Turquía
Fil: Lammert, Craig. University School of Medicine Indianapolis; Estados Unidos
Fil: Taşçılar, Koray. Universitat Erlangen-Nuremberg; Alemania
Fil: Dhanasekaran, Renumathy. University of Stanford; Estados Unidos
Fil: Ebik, Berat. Gazi Yasargil Education And Research Hospital; Turquía
Fil: Higuera de la Tijera, Fatima. Hospital General de México; México
Fil: Calışkan, Ali R.. No especifíca;
Fil: Peralta, Mirta. Gobierno de la Ciudad de Buenos Aires. Hospital de Infecciosas "Dr. Francisco Javier Muñiz"; Argentina
Fil: Gerussi, Alessio. Università degli Studi di Milano; Italia
Fil: Massoumi, Hatef. No especifíca;
Fil: Catana, Andreea M.. Harvard Medical School; Estados Unidos
Fil: Purnak, Tugrul. University of Texas; Estados Unidos
Fil: Rigamonti, Cristina. Università del Piemonte Orientale ; Italia
Fil: Aldana, Andres J. G.. Fundacion Santa Fe de Bogota; Colombia
Fil: Khakoo, Nidah. Miami University; Estados Unidos
Fil: Nazal, Leyla. Clinica Las Condes; Chile
Fil: Frager, Shalom. Montefiore Medical Center; Estados Unidos
Fil: Demir, Nurhan. Haseki Training And Research Hospital; Turquía
Fil: Irak, Kader. Kanuni Sultan Suleyman Training And Research Hospital; Turquía
Fil: Melekoğlu Ellik, Zeynep. Ankara University Medical Faculty; Turquía
Fil: Kacmaz, Hüseyin. Adıyaman University; Turquía
Fil: Balaban, Yasemin. Hacettepe University; Turquía
Fil: Atay, Kadri. No especifíca;
Fil: Eren, Fatih. No especifíca;
Fil: Alvares da-Silva, Mario R.. Universidade Federal do Rio Grande do Sul; Brasil
Fil: Cristoferi, Laura. Università degli Studi di Milano; Italia
Fil: Urzua, Álvaro. Universidad de Chile; Chile
Fil: Eşkazan, Tuğçe. Cerrahpaşa School of Medicine; Turquía
Fil: Magro, Bianca. No especifíca;
Fil: Snijders, Romee. No especifíca;
Fil: Barutçu, Sezgin. No especifíca;
Fil: Lytvyak, Ellina. University of Alberta; Canadá
Fil: Zazueta, Godolfino M.. Instituto Nacional de la Nutrición Salvador Zubiran; México
Fil: Demirezer Bolat, Aylin. Ankara City Hospital; Turquía
Fil: Aydın, Mesut. Van Yuzuncu Yil University; Turquía
Fil: Amorós Martín, Alexandra Noemí. No especifíca;
Fil: De Martin, Eleonora. No especifíca;
Fil: Ekin, Nazım. No especifíca;
Fil: Yıldırım, Sümeyra. No especifíca;
Fil: Yavuz, Ahmet. No especifíca;
Fil: Bıyık, Murat. Necmettin Erbakan University; Turquía
Fil: Narro, Graciela C.. Instituto Nacional de la Nutrición Salvador Zubiran; México
Fil: Bıyık, Murat. Uludag University; Turquía
Fil: Kıyıcı, Murat. No especifíca;
Fil: Kahramanoğlu Aksoy, Evrim. No especifíca;
Fil: Vincent, Maria. No especifíca;
Fil: Carr, Rotonya M.. University of Pennsylvania; Estados Unidos
Fil: Günşar, Fulya. No especifíca;
Fil: Reyes, Eira C.. Hepatology Unit. Hospital Militar Central de México; México
Fil: Harputluoğlu, Murat. Inönü University School of Medicine; Turquía
Fil: Aloman, Costica. Rush University Medical Center; Estados Unidos
Fil: Gatselis, Nikolaos K.. University Hospital Of Larissa; Grecia
Fil: Üstündağ, Yücel. No especifíca;
Fil: Brahm, Javier. Clinica Las Condes; Chile
Fil: Vargas, Nataly C. E.. Hospital Nacional Almanzor Aguinaga Asenjo; Perú
Fil: Güzelbulut, Fatih. No especifíca;
Fil: Garcia, Sandro R.. Hospital Iv Víctor Lazarte Echegaray; Perú
Fil: Aguirre, Jonathan. Hospital Angeles del Pedregal; México
Fil: Anders, Margarita. Hospital Alemán; Argentina
Fil: Ratusnu, Natalia. Hospital Regional de Ushuaia; Argentina
Fil: Hatemi, Ibrahim. No especifíca;
Fil: Mendizabal, Manuel. Universidad Austral; Argentina
Fil: Floreani, Annarosa. Università di Padova; Italia
Fil: Fagiuoli, Stefano. No especifíca;
Fil: Silva, Marcelo. Universidad Austral; Argentina
Fil: Idilman, Ramazan. No especifíca;
Fil: Satapathy, Sanjaya K.. No especifíca;
Fil: Silveira, Marina. University of Yale. School of Medicine; Estados Unidos
Fil: Drenth, Joost P. H.. No especifíca;
Fil: Dalekos, George N.. No especifíca;
Fil: N.Assis, David. University of Yale. School of Medicine; Estados Unidos
Fil: Björnsson, Einar. No especifíca;
Fil: Boyer, James L.. University of Yale. School of Medicine; Estados Unidos
Fil: Yoshida, Eric M.. University of British Columbia; Canadá
Fil: Invernizzi, Pietro. Università degli Studi di Milano; Italia
Fil: Levy, Cynthia. University of Miami; Estados Unidos
Fil: Montano Loza, Aldo J.. University of Alberta; Canadá
Fil: Schiano, Thomas D.. No especifíca;
Fil: Ridruejo, Ezequiel. Universidad Austral; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. CEMIC-CONICET. Centro de Educaciones Médicas e Investigaciones Clínicas "Norberto Quirno". CEMIC-CONICET; Argentina
Fil: Wahlin, Staffan. No especifíca;