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Hvidovre Hospital - a part of Copenhagen University Hospital
E-pub ahead of print

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

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  • Daniel Ward
  • Sanne Gørtz
  • Martin Thomsen Ernst
  • Nynne Nyboe Andersen
  • Susanne K Kjær
  • Jesper Hallas
  • Steffen Christensen
  • Christian Fynbo Christiansen
  • Simone Bastrup Israelsen
  • Thomas Benfield
  • Anton Pottegård
  • Tine Jess
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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.

Original languageEnglish
JournalThe European respiratory journal
ISSN0903-1936
DOIs
Publication statusE-pub ahead of print - 2 Sep 2021

ID: 67608989