The association between pre-exposure to glucocorticoids and other immunosuppressant drugs with severe COVID-19 outcomes

Brodin, Rakel; Werff, Suzanne D. van der; Hedberg, Pontus; Färnert, Anna; Nauclér, Pontus; Bergman, Peter; Requena‐Méndez, Ana

doi:10.1016/j.cmi.2022.05.014

Cited by 6 publications

(3 citation statements)

References 22 publications

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“…Both immune-mediated inflammatory diseases [ 311 ] (e.g., rheumatoid arthritis [ 201 ]) which are characterized by dysfunctional cytokine responses, and the use of immunosuppressant medications [ 13 , 280 ], have been associated with poor COVID-19 outcomes. Special attention has been given to glucocorticoids [ 319 , 321 , 401 , 402 ]. While dexamethasone has been demonstrated to reduce mortality with severe/critical COVID-19 [ 403 ], it has also been shown that chronic (and especially high-dose) intake of glucocorticoids, and use in mild cases are connected to increased hospitalization and mortality [ 401 ].…”

Section: Host Factorsmentioning

confidence: 99%

Risk Factors of Severe COVID-19: A Review of Host, Viral and Environmental Factors

Zsichla

Müller

2023

Viruses

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The clinical course and outcome of COVID-19 are highly variable, ranging from asymptomatic infections to severe disease and death. Understanding the risk factors of severe COVID-19 is relevant both in the clinical setting and at the epidemiological level. Here, we provide an overview of host, viral and environmental factors that have been shown or (in some cases) hypothesized to be associated with severe clinical outcomes. The factors considered in detail include the age and frailty, genetic polymorphisms, biological sex (and pregnancy), co- and superinfections, non-communicable comorbidities, immunological history, microbiota, and lifestyle of the patient; viral genetic variation and infecting dose; socioeconomic factors; and air pollution. For each category, we compile (sometimes conflicting) evidence for the association of the factor with COVID-19 outcomes (including the strength of the effect) and outline possible action mechanisms. We also discuss the complex interactions between the various risk factors.

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Section: Host Factorsmentioning

confidence: 99%

Risk Factors of Severe COVID-19: A Review of Host, Viral and Environmental Factors

Zsichla

Müller

2023

Viruses

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“…In traditional understanding, immunosuppressants have been presumed to hinder cytokines and immune cells, exerting an inhibitory effect on the immune system that could potentially lead to adverse consequences following COVID‐19 infection 26 . However, several studies have suggested that long‐term use of conventional synthetic DMARDs and biologic DMARDs does not increase the risk of severe outcomes among Caucasians, 27 with one study even indicating a potential reduction in the need for mechanical ventilation 28 . Conversely, other research has hinted at a possible association between rituximab, an anti‐CD20 antibody, and a higher risk of severe COVID‐19 outcomes 29,30 .…”

Section: Discussionmentioning

confidence: 99%

Do rheumatic diseases, long‐term glucocorticoids, and immunosuppressant treatment, and vaccination impact the COVID‐19 severity? Insight from a retrospective cohort study

Ma,

Wei,

et al. 2024

Int J of Rheum Dis

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ObjectivesThe impact of rheumatic diseases, long‐term medication, and vaccination on COVID‐19 severity remain insufficiently understood, hindering effective patient management. This study aims to investigate factors influencing COVID‐19 severity in Chinese rheumatic patients and to provide real‐world evidence for patient care.MethodsWe conducted a retrospective observational study consisting of two cohorts, followed by a nested case–control analysis. The outpatient cohort included non‐severe COVID‐19 patients, while the inpatient cohort included consecutive severe COVID‐19 inpatients. Additionally, rheumatic patients from both cohorts were included for the nested case–control study. Clinical information was obtained from electronic medical records and surveys.ResultsA total of 749 outpatients and 167 inpatients were enrolled. In the outpatient cohort, rheumatic diseases were identified as a risk factor for the severity of dyspnea (No rheumatic disease: OR = 0.577, 95% CI = 0.396–0.841, p = .004), but not for mortality, length of hospitalization, or hospitalization costs in the inpatient cohort. Long‐term glucocorticoids use was identified as an independent risk factor for severity of dyspnea in rheumatic patients (OR = 1.814, 95% CI = 1.235–2.663, p = .002), while vaccination and immunosuppressant treatment showed no association. Vaccination was identified as a protective factor against hospitalization due to COVID‐19 in patients with rheumatic diseases (OR = 0.031, 95% CI = 0.007–0.136, p < .001), whereas long‐term glucocorticoids and immunosuppressant treatment showed no association.ConclusionsRheumatic diseases and long‐term glucocorticoids use are significant risk factors for COVID‐19 severity in the Chinese population, whereas emphasizing the protective effects of vaccines against COVID‐19 severity is crucial. Additionally, the investigation provides preliminary support for the concept that long‐term immunosuppressant therapy does not necessarily require additional prescription adjustments.

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“…Also, diabetes/antidiabetics [ 11 – 13 ], cardiovascular disease and its treatment [ 14 ], sex steroids [ 15 , 16 ], corticosteroids [ 17 ] and hypertension/antihypertensives [ 18 , 19 ] have been identified as factors affecting the outcome of COVID-19 infection.…”

Section: Introductionmentioning

confidence: 99%

COVID-19 and comedications in atrial fibrillation—a case–control study in Stockholm

2023

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To test the main hypothesis that anticoagulation reduces risk of hospitalization, intensive care unit (ICU) admission and death in COVID-19. Nested case–control study among patients with atrial fibrillation (AF) in Stockholm. COVID-19 cases were matched to five disease-free controls with same sex, born within ± 1 years. Source population was individuals in Stockholm with AF 1997–2020. Swedish regional and national registers are used. National registers cover hospitals and outpatient clinics, local registers cover primary care. Records were linked through the personal identity number assigned to each Swedish resident. Cases were individuals with COVID-19 (diagnosis, ICU admission, or death). The AF source population consisted of 179,381 individuals from which 7548 cases were identified together with 37,145 controls. The number of cases (controls) identified from hospitalization, ICU admission or death were 5916 (29,035), 160 (750) and 1472 (7,360). The proportion of women was 40% for hospitalization and death, but 20% and 30% for admission to ICU in wave one and two, respectively. Primary outcome was mortality, secondary outcome was hospitalization, tertiary outcome was ICU admission, all with COVID-19. Odds ratios (95% confidence interval) for antithrombotics were 0.79 (0.66–0.95) for the first wave and 0.80 (0.64–1.01) for the second wave. Use of anticoagulation among patients with arrythmias infected with COVID-19 is associated with lower risk of hospitalization and death. If further COVID-variants emerge, or other infections with prothrombotic properties, this emphasize need for physicians to ensure compliance among vulnerable patients.

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The association between pre-exposure to glucocorticoids and other immunosuppressant drugs with severe COVID-19 outcomes

Cited by 6 publications

References 22 publications

Risk Factors of Severe COVID-19: A Review of Host, Viral and Environmental Factors

Risk Factors of Severe COVID-19: A Review of Host, Viral and Environmental Factors

Do rheumatic diseases, long‐term glucocorticoids, and immunosuppressant treatment, and vaccination impact the COVID‐19 severity? Insight from a retrospective cohort study

COVID-19 and comedications in atrial fibrillation—a case–control study in Stockholm

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