Immunosuppressant Effects on the Prognosis of SARS-CoV-2 Infection
abstract
This abstract is available on the publisher's site.
Access this abstract nowBACKGROUND
Immunosuppression may worsen SARS-CoV-2 infection. We conducted a nationwide cohort study of the effect of exposure to immunosuppressants on the prognosis of SARS-CoV-2 infection in Denmark.
METHODS
We identified all SARS-CoV-2 test-positive patients from February to October 2020 and linked health care data from nationwide registers, including prescriptions for the exposure, immunosuppressant drugs. We estimated relative risks of hospital admission, intensive care unit (ICU) admission, and death (each studied independently up to 30 days from testing) with a log linear binomial regression adjusted for confounders using a propensity score-based matching weights model.
RESULTS
A composite immunosuppressant exposure was associated with a significantly increased risk of death (adjusted relative risk 1·56 [95% confidence interval 1.10-2.22]). The increased risk of death was mainly driven by exposure to systemic glucocorticoids (aRR 2.38 [95% CI 1.72-3.30]), which were also associated with an increased risk of hospital admission (aRR 1.34 [95% CI 1.10-1.62]), but not ICU admission (aRR 1.76 [95% CI [0.93-3.35]); these risks were greater for high cumulative doses of glucocorticoids than for moderate doses. Exposure to selective immunosuppressants, tumour necrosis factor inhibitors, or interleukin inhibitors, was not associated with an increased risk of hospitalisation, ICU admission, or death, nor was exposure to calcineurin inhibitors, other immunosuppressants, hydroxychloroquine, or chloroquine.
CONCLUSIONS
Exposure to glucocorticoids was associated with increased risks of hospital admission and death. Further investigation is needed to determine the optimal management of COVID-19 in patients with pre-morbid glucocorticoid usage, specifically whether these patients require altered doses of glucocorticoids.
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Additional Info
Disclosure statements are available on the authors' profiles:
The effect of immunosuppressants on the prognosis of SARS-CoV-2 infection
Eur. Respir. J. 2021 Sep 02;[EPub Ahead of Print], D Ward, S Gørtz, MT Ernst, NN Andersen, SK Kjær, J Hallas, S Christensen, CF Christiansen, SB Israelsen, T Benfield, A Pottegård, T JessFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.