Effects of immunosuppressive drugs on COVID‐19 severity in patients with autoimmune hepatitis
Authors: 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 , Heurgue‐Berlot Alexandra , De Martin Eleonora , Ekin Nazım , Yıldırım Sümeyra , Yavuz Ahmet , Bıyık Murat , Narro Graciela C. , Kıyıcı Murat , Akyıldız 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 
Published: November 2021

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.