Effects of immunosuppressive drugs on COVID‐19 severity in patients with autoimmune hepatitis
Makaleler > Tam Makale · 2021
Yazarlar: Cumali Efe, Craig Lammert, Koray Tascilar, Renumathy Dhanasekaran, Berat Ebik, Fatima Higuera-de la Tijera, Ali R. Caliskan, 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 Melekoglu-Ellik, Huseyin Kacmaz, Yasemin Balaban, Kadri Atay, Fatih Eren, Mario R. Alvares-da-Silva, Laura Cristoferi, Alvaro Urzua, Tuğçe EŞKAZAN, Bianca Magro, Romee Snijders, Sezgin Barutcu, Ellina Lytvyak, Godolfino M. Zazueta, Aylin Demirezer-Bolat, Mesut Aydın, Alexandra Heurgue-Berlot, Eleonora De Martin, Nazim Ekin, Sumeyra Yildirim, Ahmet Yavuz, MURAT BIYIK, Graciela C. Narro, MURAT KIYICI, Murat Akyildiz, Evrim Kahramanoglu-Aksoy, Maria Vincent, Rotonya M. Carr, Fulya GÜNŞAR, Eira C. Reyes, Murat Harputluoglu, Costica Aloman, Nikolaos K. Gatselis, Yucel Ustundag, Javier Brahm, Nataly C. E. Vargas, Fatih Guzelbulut, Sandro R. Garcia, Jonathan Aguirre, Margarita Anders, Natalia Ratusnu, ALİ İBRAHİM HATEMİ, Manuel Mendizabal, Annarosa Floreani, Stefano Fagiuoli, Marcelo Silva, RAMAZAN İDİLMAN, Sanjaya K. Satapathy, Marina Silveira, Joost P. H. Drenth, George N. Dalekos, David N. Assis, Einar Bjornsson, James L. Boyer, Eric M. Yoshida, Pietro Invernizzi, Cynthia Levy, Aldo J. Montano-Loza, Thomas D. Schiano, Ezequiel Ridruejo, Staffan Wahlin
Liver International, SCI Expanded İndekslerine Giren Dergi, Uluslararası, Wos, 2021, cilt 42, ss 607-614
DOI: 10.1111/liv.15121
Özet
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.