Are there any association between COVID-19 severity and immunosuppressive therapy?

Hormati, Ahmad; Ghadir, Mohammad Reza; Zamani, Farhad; Khodadadi, Javad; Khodadust, Fatemeh; Afifian, Mahboubeh; Aminnejad, Reza

doi:10.1016/j.imlet.2020.05.002

Cited by 16 publications

(15 citation statements)

References 5 publications

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“… 12 , 20 , 21 , 28 , 30–33 Fourteen studies ( n = 50,706) provided the information on prevalence that included IBD patients with and without COVID-19 ( Table 2 ). 12 , 16 , 20 , 21 , 23 , 24 , 26–28 , 30–34 The pooled prevalence of infection was 1.0% (95% confidence interval [CI], 0.92-1.10).…”

Section: Resultsmentioning

confidence: 99%

“…Thirteen studies described COVID 19 symptoms in IBD patients. 14 , 15 , 17–21 , 23 , 26 , 28 , 30–32 Fevers and cough were the most common presenting symptoms: 488 (41.9%) patients reported fever, and 427 (36.7%) reported cough. Diarrhea was the most common gastrointestinal symptom: 160 (13.8%) patients reported diarrhea; 78 (6.7%) patients reported nausea and vomiting; and 57 (4.9%) patients reported abdominal pain ( Supplemental Table 5 ).…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

COVID-19 and Outcomes in Patients With Inflammatory Bowel Disease: Systematic Review and Meta-Analysis

Tripathi

Brewer

Nguyen³

et al. 2021

Inflammatory Bowel Diseases

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Background Our understanding of coronavirus disease 2019 (COVID-19) and its implications for patients with inflammatory bowel diseases (IBD) is rapidly evolving. We performed a systematic review and meta-analysis to investigate the epidemiology, clinical characteristics, and outcomes in IBD patients with COVID-19. Methods We searched PubMed, EMBASE, Cochrane Central, Clinicaltrials.gov, Web of Science, MedRxiv, and Google Scholar from inception through October 2020. We included studies with IBD patients and confirmed COVID-19. Data were collected on the prevalence, patient characteristics, pre-infection treatments for IBD, comorbidities, hospitalization, intensive care unit (ICU), admission, and death. Results Twenty-three studies with 51,643 IBD patients and 1449 with COVID-19 met our inclusion criteria. In 14 studies (n = 50,706) that included IBD patients with and without COVID-19, the prevalence of infection was 1.01% (95% confidence interval [CI], 0.92-1.10). Of IBD patients with COVID-19, 52.7% had Crohn’s disease, 42.2% had ulcerative colitis, and 5.1% had indeterminate colitis. Nine studies (n = 687) reported outcomes according to IBD therapy received. Compared with patients on corticosteroids, those on antitumor necrosis factor (anti-TNF) therapy had a lower risk of hospitalization (risk ratio [RR], 0.24; 95% CI, 0.16-0.35; P < .01; I2 = 0%) and ICU admission (RR, 0.10; 95% CI, 0.03-0.37; P < .01) but not death (RR, 0.16; 95% CI, 0.02-1.71; P = .13; I2 = 39%). Compared with patients on mesalamine, those on antitumor necrosis factor therapy had a lower risk of hospitalizations (RR, 0.37; 95% CI, 0.25-0.54), ICU admissions (RR, 0.20; 95% CI, 0.07-0.58), and death (0.21; 95% CI, 0.04-1.00). Comparing patients on immunomodulators vs mesalamine or anti-TNF therapy, there was no difference in these outcomes. Conclusions The prevalence of COVID-19 in IBD patients was low. Use of corticosteroids or mesalamine was significantly associated with worse outcomes, whereas use of anti-TNFs was associated with more favorable outcomes. Further investigation clarifying the mechanisms of these disparate observations could help identify risk and adverse outcome-mitigating strategies for patients with IBD.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

COVID-19 and Outcomes in Patients With Inflammatory Bowel Disease: Systematic Review and Meta-Analysis

Tripathi

Brewer

Nguyen³

et al. 2021

Inflammatory Bowel Diseases

View full text Add to dashboard Cite

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“…These null results regarding severe outcomes are concordant with earlier data on other immune-mediated diseases. 26 , 27 …”

Section: Discussionmentioning

confidence: 99%

Risk of Severe Covid-19 in Patients with Celiac Disease: A Population-Based Cohort Study

Lebwohl¹,

Larsson²,

Söderling³

et al. 2021

CLEP

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Background Patients with celiac disease (CeD) are at increased risk of certain viral infections and of pneumococcal pneumonia, raising concerns that they may be susceptible to severe coronavirus disease 2019 (Covid-19). We aimed to quantify the association between CeD and severe outcomes related to Covid-19. Methods We performed a population-based cohort study, identifying individuals with CeD in Sweden, as defined by small intestinal villus atrophy diagnosed at all (n=28) Swedish pathology departments during the years spanning 1969–2017, and alive on February 1, 2020. We compared these patients to controls matched by sex, age, county, and calendar period. We performed Cox proportional hazards with follow-up through July 31, 2020, assessing risk of 1) hospital admission with a primary diagnosis of laboratory-confirmed Covid-19 (co-primary outcome); and 2) severe disease as defined by admission to intensive care unit and/or death attributed to Covid-19 (co-primary outcome). Results Among patients with CeD (n=40,963) and controls (n=183,892), the risk of hospital admission for Covid-19 was 2.9 and 2.2 per 1000 person-years respectively. After adjusting for comorbidities, the risk of hospitalization for Covid-19 was not significantly increased in patients with CeD (HR 1.10; 95% CI 0.80–1.50), nor was the risk of severe Covid-19 increased (HR 0.97; 95% CI 0.59–1.59). Results were similarly null when we compared CeD patients to their non-CeD siblings with regard to these outcomes. Among all patients with CeD and controls hospitalized with a diagnosis of Covid-19 (n=58 and n=202, respectively), there was no significant difference in mortality (HR for CeD compared to controls 0.96; 95% CI 0.46–2.02). Conclusion In this population-based study, CeD was not associated with an increased risk of hospitalization for Covid-19 or intensive care unit and/or death attributed to Covid-19.

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“…The only compounds identified by the in silico analysis which performed well in the retrospective epidemiologic validation (Figure 5) are azathioprine and retinol. Immunosuppressive therapy (including azathioprine as a monotherapy or combination therapy) has been proposed to be beneficial in a small retrospective study 70 but there is conflicting evidence regarding azathioprine treatment in a COVID-19 ferret model 71 . For retinol (vitamin A), a recent study of molecular simulations identified it as a potential ligand that may stabilize the closed conformation of the spike protein thus possibly reducing the opportunity for ACE2 interaction 72 ; alternative mechanisms have been hypothesized but not experimentally tested [73][74][75][76] .…”

Section: Discussionmentioning

confidence: 99%

IL10RB as a key regulator of COVID-19 host susceptibility and severity

Voloudakis

Hoffman

Venkatesh

et al. 2021

Preprint

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Background Recent efforts have identified genetic loci that are associated with coronavirus disease 2019 (COVID-19) infection rates and disease outcome severity. Translating these genetic findings into druggable genes and readily available compounds that reduce COVID-19 host susceptibility is a critical next step. Methods We integrate COVID-19 genetic susceptibility variants, multi-tissue genetically regulated gene expression (GReX) and perturbargen signatures to identify candidate genes and compounds that reverse the predicted gene expression dysregulation associated with COVID-19 susceptibility. The top candidate gene is validated by testing both its GReX and observed blood transcriptome association with COVID-19 severity, as well as by in vitro perturbation to quantify effects on viral load and molecular pathway dysregulation. We validate the in silico drug repositioning analysis by examining whether the top candidate compounds decrease COVID-19 incidence based on epidemiological evidence. Results We identify IL10RB as the top key regulator of COVID-19 host susceptibility. Predicted GReX up-regulation of IL10RB and higher IL10RB expression in COVID-19 patient blood is associated with worse COVID-19 outcomes. In vitro IL10RB overexpression is associated with increased viral load and activation of immune-related molecular pathways. Azathioprine and retinol are prioritized as candidate compounds to reduce the likelihood of testing positive for COVID-19. Conclusions We establish an integrative data-driven approach for gene target prioritization. We identify and validate IL10RB as a suitable molecular target for modulation of COVID-19 host susceptibility. Finally, we provide evidence for a few readily available medications that would warrant further investigation as drug repositioning candidates.

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Are there any association between COVID-19 severity and immunosuppressive therapy?

Cited by 16 publications

References 5 publications

COVID-19 and Outcomes in Patients With Inflammatory Bowel Disease: Systematic Review and Meta-Analysis

COVID-19 and Outcomes in Patients With Inflammatory Bowel Disease: Systematic Review and Meta-Analysis

Risk of Severe Covid-19 in Patients with Celiac Disease: A Population-Based Cohort Study

IL10RB as a key regulator of COVID-19 host susceptibility and severity

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