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The effect of immunosuppressants on the prognosis of SARS-CoV-2 infection

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Harvard

Ward, D, Gørtz, S, Ernst, MT, Andersen, NN, Kjær, SK, Hallas, J, Christensen, S, Christiansen, CF, Israelsen, SB, Benfield, T, Pottegård, A & Jess, T 2021, 'The effect of immunosuppressants on the prognosis of SARS-CoV-2 infection', The European respiratory journal. https://doi.org/10.1183/13993003.00769-2021

APA

Ward, D., Gørtz, S., Ernst, M. T., Andersen, N. N., Kjær, S. K., Hallas, J., Christensen, S., Christiansen, C. F., Israelsen, S. B., Benfield, T., Pottegård, A., & Jess, T. (2021). The effect of immunosuppressants on the prognosis of SARS-CoV-2 infection. The European respiratory journal. https://doi.org/10.1183/13993003.00769-2021

CBE

Ward D, Gørtz S, Ernst MT, Andersen NN, Kjær SK, Hallas J, Christensen S, Christiansen CF, Israelsen SB, Benfield T, Pottegård A, Jess T. 2021. The effect of immunosuppressants on the prognosis of SARS-CoV-2 infection. The European respiratory journal. https://doi.org/10.1183/13993003.00769-2021

MLA

Vancouver

Author

Ward, Daniel ; Gørtz, Sanne ; Ernst, Martin Thomsen ; Andersen, Nynne Nyboe ; Kjær, Susanne K ; Hallas, Jesper ; Christensen, Steffen ; Christiansen, Christian Fynbo ; Israelsen, Simone Bastrup ; Benfield, Thomas ; Pottegård, Anton ; Jess, Tine. / The effect of immunosuppressants on the prognosis of SARS-CoV-2 infection. I: The European respiratory journal. 2021.

Bibtex

@article{4f7d4193a83b408d9caca459960b810d,
title = "The effect of immunosuppressants on the prognosis of SARS-CoV-2 infection",
abstract = "BACKGROUND: 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.",
author = "Daniel Ward and Sanne G{\o}rtz and Ernst, {Martin Thomsen} and Andersen, {Nynne Nyboe} and Kj{\ae}r, {Susanne K} and Jesper Hallas and Steffen Christensen and Christiansen, {Christian Fynbo} and Israelsen, {Simone Bastrup} and Thomas Benfield and Anton Potteg{\aa}rd and Tine Jess",
note = "Copyright {\textcopyright}The authors 2021.",
year = "2021",
month = sep,
day = "2",
doi = "10.1183/13993003.00769-2021",
language = "English",
journal = "European Respiratory Journal",
issn = "0903-1936",
publisher = "European Respiratory Society",

}

RIS

TY - JOUR

T1 - The effect of immunosuppressants on the prognosis of SARS-CoV-2 infection

AU - Ward, Daniel

AU - Gørtz, Sanne

AU - Ernst, Martin Thomsen

AU - Andersen, Nynne Nyboe

AU - Kjær, Susanne K

AU - Hallas, Jesper

AU - Christensen, Steffen

AU - Christiansen, Christian Fynbo

AU - Israelsen, Simone Bastrup

AU - Benfield, Thomas

AU - Pottegård, Anton

AU - Jess, Tine

N1 - Copyright ©The authors 2021.

PY - 2021/9/2

Y1 - 2021/9/2

N2 - BACKGROUND: 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.

AB - BACKGROUND: 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.

U2 - 10.1183/13993003.00769-2021

DO - 10.1183/13993003.00769-2021

M3 - Journal article

C2 - 34475227

JO - European Respiratory Journal

JF - European Respiratory Journal

SN - 0903-1936

ER -

ID: 67608989