Cyclosporine may reduce the risk of symptomatic COVID-19 in patients with systemic lupus erythematosus: a retrospective cohort study

• Published in: Microbiology spectrum 2024-11, Vol.12 (11), p.e0127624
• Main Authors: Li, He-Jun, Lin, Shu-Huan, Wang, Yan-Qing, Chen, Ling, Zheng, Xiang-Xiong, Wei, Li-Xin
• Format: Article
• Language: English
• Subjects: Adult; Clinical Microbiology; COVID-19; COVID-19 - complications; COVID-19 - prevention & control; COVID-19 Drug Treatment; cyclosporine; Cyclosporine - therapeutic use; Female; Glucocorticoids - therapeutic use; Humans; Hydroxychloroquine - therapeutic use; Immunosuppressive Agents - adverse effects; Immunosuppressive Agents - therapeutic use; immunosuppressive therapy; Lupus Erythematosus, Systemic - complications; Lupus Erythematosus, Systemic - drug therapy; Male; Middle Aged; Research Article; Retrospective Studies; Risk Factors; SARS-CoV-2; systemic lupus erythematosus
• ISSN: 2165-0497; 2165-0497
• DOI: 10.1128/spectrum.01276-24

This study aimed to explore the effect of cyclosporine (CsA) on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in systemic lupus erythematosus (SLE) patients to provide a valuable reference for clinical treatment strategies in the context of the long-term risk of SARS-CoV-2 infection. SLE patients who visited the Rheumatology Outpatient Department of Fujian Medical University Union Hospital between 1 May and 31 October 2022 were included. Data on SARS-CoV-2 infection in patients between 1 November 2022 and 31 July 2023 were obtained by telephone follow-up. Patients were divided into two groups according to whether CsA was used during the observation period: the glucocorticoid or hydroxychloroquine group and the CsA group. To assess the robustness of the results, Data sets 1 and 2 were established to be analyzed independently. Multivariate logistic regression was used to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) for symptomatic coronavirus disease (COVID-19). A total of 184 patients were included, among whom 129 were definite symptomatic COVID-19 patients; 29 were presumptive symptomatic COVID-19 patients; and 4 had signs and symptoms of COVID-19, but tested negative for SARS-CoV-2 in a virological test. According to the multivariable-adjusted models, CsA was associated with lower odds of symptomatic COVID-19 ( = 0.042, OR = 0.316, 95% CI: 0.104-0.959 in Data set 1 and = 0.021, OR = 0.257, 95% CI: 0.081-0.812 in Data set 2). CsA is associated with lower odds of contracting symptomatic COVID-19. The use of CsA may be considered an appropriate therapeutic option for disease management in patients with rheumatic diseases who have severe disease activity and persistent SARS-CoV-2 infection. Our study indicated that cyclosporine may reduce the risk of symptomatic COVID-19 in systemic lupus erythematosus patients in spite of its immunosuppressive effects. This study provides a reference for clinical treatment strategies for AIIRD patients in the context of the long-term risk of SARS-CoV-2 infection.