Abstract
Objectives
Whether preinfection use of immunosuppressant drugs is associated with COVID-19 severity remains unclear. The study was aimed to determine the association between preinfection use of immunosuppressant drugs with COVID-19 outcomes within 1 month after COVID-19 diagnosis.
Methods
This cohort study included individuals aged ≥18 years with underlying conditions associated with an immunocompromised state and diagnosed with COVID-19 between February 2020 and January 2021 at Karolinska University Hospital, Stockholm.
Exposure to immunosuppressant drugs was defined based on dose and duration of drugs (glucocorticoids and drugs included in L01 or L04 chapter of Anatomical Therapeutic Chemical classification) before COVID-19 diagnosis. Outcomes included hospital admission, ICU admission, mechanical ventilation, mortality, renal failure, stroke, pulmonary embolism, and cardiac event. ORs were calculated using logistic regression and baseline covariate adjustment for confounding with inverse probability of treatment weights.
Results
Of 1067 included individuals, 444 were pre-exposed to immunosuppressive treatments before COVID-19 diagnosis (72 high-dose glucocorticoids, 255 L01 drugs (antineoplastics), 198 L04 (other immunosuppressants) and 78 to multiple drugs). There was no association between pre-exposure and hospital admission (OR 0.83, 95% CI 0.64 to 1.09) because of COVID-19. Pre-exposure to L01 or L04 drugs were not associated with hospital admission (adjusted ORs (aORs): 1.23, 0.86 to 1.76 and 1.31, 0.77 to 2.21) or other outcomes. High-dose glucocorticoids (≥20 mg/day prednisolone equivalent) were associated with hospital admission (aOR 2.50, 1.26 to 4.96), cardiac events (aOR 1.93, 1.08 to 3.46), pulmonary embolism (aOR 2.78, 1.08 to 7.15), and mortality (aOR 3.48, 1.77 to 6.86) due to COVID-19.
Discussion
Antineoplastic and other immunosuppressants drugs were not associated with COVID-19 severity whereas high-dose glucocorticoids were associated. Further studies should evaluate the effect of pre-exposure of different dose of glucocorticoids on COVID-19 prognosis.
【저자키워드】 COVID-19, Glucocorticoids, Cancer, Immunosuppression, Transplant, Autoimmune diseases, biological therapy, Antineoplastic therapy, 【초록키워드】 Treatment, Mortality, mechanical ventilation, stroke, severity, drugs, drug, outcome, immunosuppressants, glucocorticoid, cohort study, outcomes, Probability, COVID-19 diagnosis, ICU admission, Immunocompromised, Logistic regression, Hospital admission, Immunosuppressant, association, COVID-19 prognosis, Antineoplastic, Chemical, covariate adjustment, dose, Immunosuppressive treatment, exposure to, cardiac event, High-dose, 95% CI, individual, renal, Karolinska University Hospital, objective, Result, defined, calculated, adjusted, determine, underlying condition, individuals, evaluate the effect, 1.26, antineoplastics, baseline, diagnosed with COVID-19, L01, prednisolone equivalent, with COVID-19, 【제목키워드】 severe COVID-19, drug, outcome, glucocorticoid, association,