Cumali Efe1, Craig Lammert2, Koray Taşçılar3, Renumathy Dhanasekaran4, Berat Ebik5, Fatima Higuera-de la Tijera6, Ali R Calışkan7, Mirta Peralta8,9, Alessio Gerussi10,11, Hatef Massoumi12, Andreea M Catana13, Tugrul Purnak14, Cristina Rigamonti15,16, Andres J G Aldana17, Nidah Khakoo18, Leyla Nazal19, Shalom Frager12, Nurhan Demir20, Kader Irak21, Zeynep Melekoğlu-Ellik22, Hüseyin Kacmaz7, Yasemin Balaban23, Kadri Atay24, Fatih Eren25, Mario R Alvares-da-Silva26,27, Laura Cristoferi10,11, Álvaro Urzua28, Tuğçe Eşkazan29, Bianca Magro30, Romee Snijders31,32, Sezgin Barutçu33, Ellina Lytvyak34, Godolfino M Zazueta35, Aylin Demirezer-Bolat36, Mesut Aydın37, Alexandra Heurgue-Berlot38, Eleonora De Martin39, Nazım Ekin5, Sümeyra Yıldırım40, Ahmet Yavuz41, Murat Bıyık41, Graciela C Narro35, Murat Kıyıcı42, Murat Akyıldız43, Evrim Kahramanoğlu-Aksoy44, Maria Vincent45, Rotonya M Carr46, Fulya Günşar47, Eira C Reyes48, Murat Harputluoğlu49, Costica Aloman50, Nikolaos K Gatselis51, Yücel Üstündağ52, Javier Brahm53, Nataly C E Vargas54, Fatih Güzelbulut55, Sandro R Garcia56, Jonathan Aguirre57, Margarita Anders58, Natalia Ratusnu59, Ibrahim Hatemi29, Manuel Mendizabal9,60, Annarosa Floreani61,62, Stefano Fagiuoli30, Marcelo Silva9,60, Ramazan Idilman22, Sanjaya K Satapathy45, Marina Silveira63, Joost P H Drenth31,32, George N Dalekos51, David N Assis63, Einar Björnsson64, James L Boyer63, Eric M Yoshida65, Pietro Invernizzi10,11, Cynthia Levy18, Aldo J Montano-Loza34, Thomas D Schiano66, Ezequiel Ridruejo9,60,67, Staffan Wahlin68. 1. Department of Gastroenterology, Harran University Hospital, Şanlıurfa, Turkey. 2. Department of Medicine Indiana, University School of Medicine Indianapolis, Indianapolis, Indiana, USA. 3. Department of Medicine 3-Rheumatology and Immunology, Friedrich-Alexander University (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany. 4. Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University, Stanford, California, USA. 5. Department of Gastroenterology, Gazi Yaşargil Education and Research Hospital, Diyarbakir, Turkey. 6. Gastroenterology and Hepatology Unit, Hospital General de México, Ciudad de México, México. 7. Department of Gastroenterology, Adıyaman University, Adıyaman, Turkey. 8. Hepatology Section, Hospital Francisco J Muñiz, Ciudad Autónoma de Buenos Aires, Argentina. 9. Latin American Liver Research Educational and Awareness Network (LALREAN), Pilar, Argentina. 10. Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy. 11. European Reference Network on Hepatological Diseases (ERN RARE-LIVER), San Gerardo Hospital, Monza, Italy. 12. Department of Medicine, Montefiore Medical Center, Bronx, New York, USA. 13. Division of Gastroenterology/Hepatology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA. 14. Division of Gastroenterology, Hepatology and Nutrition, McGovern Medical School, Houston, Texas, USA. 15. Department of Translational Medicine, Università del Piemonte Orientale UPO, Novara, Italy. 16. Division of Internal Medicine, "AOU Maggiore della Carità", Novara, Italy. 17. Gastroenterology and Hepatology Unit, Fundación Santa Fe de Bogotá y universidad de Los Andes, Bogotá, Colombia. 18. Division of Digestive Health and Liver Diseases, University of Miami Miller School of Medicine, Miami, Florida, USA. 19. Gastroenterology and Hepatology Unit, Clínica Las Condes, Santiago de Chile, Chile. 20. Department of Gastroenterology, Haseki Training and Research Hospital, Istanbul, Turkey. 21. Department of Gastroenterology, SBU Kanuni Sultan Süleyman Training and Research Hospital, Istanbul, Turkey. 22. Department of Gastroenterology, Ankara University Medical Faculty, Ankara, Turkey. 23. Department of Gastroenterology, Faculty of Medicine, Hacettepe University, Ankara, Turkey. 24. Departmant of Gastroenterology, Mardin State Hospital, Mardin, Turkey. 25. Departmant of Gastroenterology, Ordu State Hospital, Ordu, Turkey. 26. Gastroenterology and Hepatology Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil. 27. Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil. 28. Gastroenterology and Hepatology Unit. Hospital Clínico, Universidad de Chile, Santiago de Chile, Chile. 29. Department of Gastroenterology, Cerrahpaşa School of Medicine, İstanbul, Turkey. 30. Gastroenterology Hepatology and Transplantation, ASST Papa Giovanni XXIII-Bergamo, Bergamo, Italy. 31. Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands. 32. European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Nijmegen, The Netherlands. 33. Department of Gastroenterology, University of Gaziantep Medical Faculty, Gaziantep, Turkey. 34. Division of Gastroenterology and Liver Unit, University of Alberta, Edmonton, Alberta, Canada. 35. Gastroenterology Unit, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Ciudad de México, México. 36. Department of Gastroenterology, Ankara City Hospital, Ankara, Turkey. 37. School of Medicine, Department of Gastroenterology, Van Yuzuncu Yil University, Van, Turkey. 38. Department of Hepato-Gastroenterology, CHU Reims, Reims, France. 39. Centre Hepato-Biliaire, Hôpital Paul-Brousse, FHU Hepatinov, INSERM Unit UMR 1193, Univ Paris-Saclay, Gif-sur-Yvette, France. 40. Department of Gastroenterology, Erciyes Hospital, Kayseri, Turkey. 41. Division of Gastroenterology, Meram School of Medicine, Necmettin Erbakan University, Konya, Turkey. 42. Department of Gastroenterology, Medical Faculty, Uludag University, Bursa, Turkey. 43. Department of Gastroenterology, Koc University School of Medicine, Istanbul, Turkey. 44. Department of Gastroenterology, Keçiören Training and Research Hospital, Ankara, Turkey. 45. Department of Internal Medicine, Donald and Barbara Zucker School of Medicine, Northwell Health, Manhasset, NY, USA. 46. Division of Gastroenterology, University of Pennsylvania, Philadelphia, Pennsylvania, USA. 47. Department of Gastroenterology, Ege University School of Medicine, İzmir, Turkey. 48. Hepatology Unit. Hospital Militar Central de México, Ciudad de México, México. 49. Department of Gastroenterology, Inönü University School of Medicine, Malatya, Turkey. 50. Section of Hepatology, Rush University Medical Center, Chicago, Illinois, USA. 51. Department of Medicine and Research Laboratory of Internal Medicine, National Expertise Center of Greece in Autoimmune Liver Diseases, General University Hospital of Larissa, Larissa, Greece. 52. Department of Gastroenterology, Bulent Ecevit University of Medicine, Zonguldak, Turkey. 53. Gastroenterology Unit, Clínica Las Condes, Santiago, Chile. 54. Hepatology Unit Hospital Nacional Almanzor Aguinaga Asenjo, Chiclayo, Perú. 55. Department of Gastroenterology, Haydarpaşa Numune Education and Research Hospital, İstanbul, Turkey. 56. Gastroenterology Unit, Hospital Víctor Lazarte Echegaray, Trujillo, Perú. 57. Hepatology Unit, Hospital Ángeles Pedregal, Ciudad de México, México. 58. Hepatology and Liver Transplant Unit, Hospital Alemán, Buenos Aires, Argentina. 59. Hepatology Unit, Hospital Regional de Ushuaia, Ushuaia, Argentina. 60. Hepatology and Liver Transplant Unit, Hospital Universitario Austral, Pilar, Argentina. 61. Scientific Consultant IRCCS Negrar, Verona, Italy. 62. Senior Scholar, University of Padova, Padova, Italy. 63. Department of Medicine, Section of Digestive Diseases Yale School of Medicine, New Haven, Connecticut, USA. 64. Department of Internal Medicine, Section of Gastroenterology, Landspitali University Hospital, Reykjavik, Iceland. 65. Division of Gastroenterology, University of British Columbia and Vancouver General Hospital, Vancouver, Canada. 66. Division of Liver Diseases, The Mount Sinai Medical Center, New York, New York, USA. 67. Hepatology Section, Department of Medicine, Centro de Educación Médica e Investigaciones Clínicas, CEMIC, Ciudad Autónoma de Buenos Aires, Argentina. 68. Hepatology Division, Department of Upper GI Diseases, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden.
Abstract
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.
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.
Authors: Thomas Marjot; Christiane S Eberhardt; Tobias Boettler; Luca S Belli; Marina Berenguer; Maria Buti; Rajiv Jalan; Mario U Mondelli; Richard Moreau; Daniel Shouval; Thomas Berg; Markus Cornberg Journal: J Hepatol Date: 2022-07-20 Impact factor: 30.083
Authors: Cumali Efe; Koray Taşçılar; Alessio Gerussi; Francesca Bolis; Craig Lammert; Berat Ebik; Albert Friedrich Stättermayer; Mustafa Cengiz; Dilara Turan Gökçe; Laura Cristoferi; Mirta Peralta; Hatef Massoumi; Pedro Montes; Eira Cerda; Cristina Rigamonti; Suna Yapalı; Gupse Adali; Ali Rıza Çalışkan; Yasemin Balaban; Fatih Eren; Tuğçe Eşkazan; Sezgin Barutçu; Ellina Lytvyak; Godolfino Miranda Zazueta; Meral Akdogan Kayhan; Alexandra Heurgue-Berlot; Eleonora De Martin; Ahmet Yavuz; Murat Bıyık; Graciela Castro Narro; Serkan Duman; Nelia Hernandez; Nikolaos K Gatselis; Jonathan Aguirre; Ramazan Idilman; Marcelo Silva; Manuel Mendizabal; Kadri Atay; Fatih Güzelbulut; Renumathy Dhanasekaran; Aldo J Montano-Loza; George N Dalekos; Ezequiel Ridruejo; Pietro Invernizzi; Staffan Wahlin Journal: J Autoimmun Date: 2022-09-07 Impact factor: 14.511