Brodin R, Desirée van der Werff S, Hedberg P, Färnert A, Nauclér P, Bergman P, Requena-Méndez A
Clin Microbiol Infect - (-) - [2022-05-26; online 2022-05-26]
Whether pre-infection use of immunosuppressant drugs is associated with COVID-19 severity remains unclear. The study was aimed to determine the association between pre-infection use of immunosuppressant drugs with COVID-19 outcomes within one month after COVID-19 diagnosis. This cohort study included ≥18 years-old individuals 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 ATC-classification) before COVID-19 diagnosis. Outcomes included hospital admission, ICU admission, mechanical ventilation, mortality, renal failure, stroke, pulmonary embolism, and cardiac event. Odds ratios(OR) were calculated using logistic regression and baseline covariate adjustment for confounding with inverse probability of treatment weights. 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 0.64-1.09]) due to COVID-19. Pre-exposure to L01 or L04 drugs were not associated with hospital admission (aORs: 1.23[0.86-1.76] and 1.31[0.77-2.21) or other outcomes. High-dose glucocorticoids (≥20mg/day prednisolone equivalent) were associated with hospital admission (aOR 2.50[1.26-4.96]), cardiac events (aOR 1.93,[1.08-3.46]),pulmonary embolism (aOR 2.78[1.08-7.15]) and mortality (aOR 3.48,[1.77-6.86]) due to COVID-19. 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.