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-Ellik; Hüseyin 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

doi:10.1111/liv.15121

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

Dipartimento di Medicina Traslazionale

Risultato della ricerca: Contributo su rivista › Articolo in rivista › peer review

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.

Lingua originale	Inglese
pagine (da-a)	607-614
Numero di pagine	8
Rivista	Liver International
Volume	42
Numero di pubblicazione	3
DOI	https://doi.org/10.1111/liv.15121
Stato di pubblicazione	Pubblicato - mar 2022

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10.1111/liv.15121

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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. G., Khakoo, N., Nazal, L., Frager, S., Demir, N., Irak, K., ... Wahlin, S. (2022). Effects of immunosuppressive drugs on COVID-19 severity in patients with autoimmune hepatitis. Liver International, 42(3), 607-614. https://doi.org/10.1111/liv.15121

@article{26f514c317eb437d9670137c335c5008,

title = "Effects of immunosuppressive drugs on COVID-19 severity in patients with autoimmune hepatitis",

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.",

keywords = "SARS-CoV-2, autoimmunity, azathioprine, budesonide, liver transplantation, mercaptopurine",

author = "Cumali Efe and Craig Lammert and Koray Ta{\c s}{\c c}ılar and Renumathy Dhanasekaran and Berat Ebik and {Higuera-de la Tijera}, Fatima and Calı{\c s}kan, {Ali R.} and Mirta Peralta and Alessio Gerussi and Hatef Massoumi and Catana, {Andreea M.} and Tugrul Purnak and Cristina Rigamonti and Aldana, {Andres J.G.} and Nidah Khakoo and Leyla Nazal and Shalom Frager and Nurhan Demir and Kader Irak and Zeynep Melekoğlu-Ellik and H{\"u}seyin Kacmaz and Yasemin Balaban and Kadri Atay and Fatih Eren and Alvares-da-Silva, {Mario R.} and Laura Cristoferi and {\'A}lvaro Urzua and Tuğ{\c c}e E{\c s}kazan and Bianca Magro and Romee Snijders and Sezgin Barut{\c c}u and Ellina Lytvyak and Zazueta, {Godolfino M.} and Aylin Demirezer-Bolat and Mesut Aydın and Alexandra Heurgue-Berlot and {De Martin}, Eleonora and Nazım Ekin and S{\"u}meyra Yıldırım and Ahmet Yavuz and Murat Bıyık and Narro, {Graciela C.} and Murat Kıyıcı and Murat Akyıldız and Evrim Kahramanoğlu-Aksoy and Maria Vincent and Carr, {Rotonya M.} and Fulya G{\"u}n{\c s}ar and Reyes, {Eira C.} and Murat Harputluoğlu and Costica Aloman and Gatselis, {Nikolaos K.} and Y{\"u}cel {\"U}st{\"u}ndağ and Javier Brahm and Vargas, {Nataly C.E.} and Fatih G{\"u}zelbulut and Garcia, {Sandro R.} and Jonathan Aguirre and Margarita Anders and Natalia Ratusnu and Ibrahim Hatemi and Manuel Mendizabal and Annarosa Floreani and Stefano Fagiuoli and Marcelo Silva and Ramazan Idilman and Satapathy, {Sanjaya K.} and Marina Silveira and Drenth, {Joost P.H.} and Dalekos, {George N.} and David N.Assis and Einar Bj{\"o}rnsson and Boyer, {James L.} and Yoshida, {Eric M.} and Pietro Invernizzi and Cynthia Levy and Montano-Loza, {Aldo J.} and Schiano, {Thomas D.} and Ezequiel Ridruejo and Staffan Wahlin",

note = "Publisher Copyright: {\textcopyright} 2022 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.",

year = "2022",

month = mar,

doi = "10.1111/liv.15121",

language = "English",

volume = "42",

pages = "607--614",

journal = "Liver International",

issn = "1478-3223",

publisher = "Wiley-Blackwell Publishing Ltd",

number = "3",

}

Efe, C, Lammert, C, Taşçılar, K, Dhanasekaran, R, Ebik, B, Higuera-de la Tijera, F, Calışkan, AR, Peralta, M, Gerussi, A, Massoumi, H, Catana, AM, Purnak, T, Rigamonti, C, Aldana, AJG, Khakoo, N, Nazal, L, Frager, S, Demir, N, Irak, K, Melekoğlu-Ellik, Z, Kacmaz, H, Balaban, Y, Atay, K, Eren, F, Alvares-da-Silva, MR, Cristoferi, L, Urzua, Á, Eşkazan, T, Magro, B, Snijders, R, Barutçu, S, Lytvyak, E, Zazueta, GM, Demirezer-Bolat, A, Aydın, M, Heurgue-Berlot, A, De Martin, E, Ekin, N, Yıldırım, S, Yavuz, A, Bıyık, M, Narro, GC, Kıyıcı, M, Akyıldız, M, Kahramanoğlu-Aksoy, E, Vincent, M, Carr, RM, Günşar, F, Reyes, EC, Harputluoğlu, M, Aloman, C, Gatselis, NK, Üstündağ, Y, Brahm, J, Vargas, NCE, Güzelbulut, F, Garcia, SR, Aguirre, J, Anders, M, Ratusnu, N, Hatemi, I, Mendizabal, M, Floreani, A, Fagiuoli, S, Silva, M, Idilman, R, Satapathy, SK, Silveira, M, Drenth, JPH, Dalekos, GN, N.Assis, D, Björnsson, E, Boyer, JL, Yoshida, EM, Invernizzi, P, Levy, C, Montano-Loza, AJ, Schiano, TD, Ridruejo, E & Wahlin, S 2022, 'Effects of immunosuppressive drugs on COVID-19 severity in patients with autoimmune hepatitis', Liver International, vol. 42, n. 3, pagg. 607-614. https://doi.org/10.1111/liv.15121

TY - JOUR

T1 - Effects of immunosuppressive drugs on COVID-19 severity in patients with autoimmune hepatitis

AU - Efe, Cumali

AU - Lammert, Craig

AU - Taşçılar, Koray

AU - Dhanasekaran, Renumathy

AU - Ebik, Berat

AU - Higuera-de la Tijera, Fatima

AU - Calışkan, Ali R.

AU - Peralta, Mirta

AU - Gerussi, Alessio

AU - Massoumi, Hatef

AU - Catana, Andreea M.

AU - Purnak, Tugrul

AU - Rigamonti, Cristina

AU - Aldana, Andres J.G.

AU - Khakoo, Nidah

AU - Nazal, Leyla

AU - Frager, Shalom

AU - Demir, Nurhan

AU - Irak, Kader

AU - Melekoğlu-Ellik, Zeynep

AU - Kacmaz, Hüseyin

AU - Balaban, Yasemin

AU - Atay, Kadri

AU - Eren, Fatih

AU - Alvares-da-Silva, Mario R.

AU - Cristoferi, Laura

AU - Urzua, Álvaro

AU - Eşkazan, Tuğçe

AU - Magro, Bianca

AU - Snijders, Romee

AU - Barutçu, Sezgin

AU - Lytvyak, Ellina

AU - Zazueta, Godolfino M.

AU - Demirezer-Bolat, Aylin

AU - Aydın, Mesut

AU - Heurgue-Berlot, Alexandra

AU - De Martin, Eleonora

AU - Ekin, Nazım

AU - Yıldırım, Sümeyra

AU - Yavuz, Ahmet

AU - Bıyık, Murat

AU - Narro, Graciela C.

AU - Kıyıcı, Murat

AU - Akyıldız, Murat

AU - Kahramanoğlu-Aksoy, Evrim

AU - Vincent, Maria

AU - Carr, Rotonya M.

AU - Günşar, Fulya

AU - Reyes, Eira C.

AU - Harputluoğlu, Murat

AU - Aloman, Costica

AU - Gatselis, Nikolaos K.

AU - Üstündağ, Yücel

AU - Brahm, Javier

AU - Vargas, Nataly C.E.

AU - Güzelbulut, Fatih

AU - Garcia, Sandro R.

AU - Aguirre, Jonathan

AU - Anders, Margarita

AU - Ratusnu, Natalia

AU - Hatemi, Ibrahim

AU - Mendizabal, Manuel

AU - Floreani, Annarosa

AU - Fagiuoli, Stefano

AU - Silva, Marcelo

AU - Idilman, Ramazan

AU - Satapathy, Sanjaya K.

AU - Silveira, Marina

AU - Drenth, Joost P.H.

AU - Dalekos, George N.

AU - N.Assis, David

AU - Björnsson, Einar

AU - Boyer, James L.

AU - Yoshida, Eric M.

AU - Invernizzi, Pietro

AU - Levy, Cynthia

AU - Montano-Loza, Aldo J.

AU - Schiano, Thomas D.

AU - Ridruejo, Ezequiel

AU - Wahlin, Staffan

PY - 2022/3

Y1 - 2022/3

N2 - 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.

AB - 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.

KW - SARS-CoV-2

KW - autoimmunity

KW - azathioprine

KW - budesonide

KW - liver transplantation

KW - mercaptopurine

UR - http://www.scopus.com/inward/record.url?scp=85121047570&partnerID=8YFLogxK

U2 - 10.1111/liv.15121

DO - 10.1111/liv.15121

M3 - Article

SN - 1478-3223

VL - 42

SP - 607

EP - 614

JO - Liver International

JF - Liver International

IS - 3

ER -

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

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