Hospitalization for COVID‐19 in patients treated with selected immunosuppressant and immunomodulating agents, compared to the general population: A Danish cohort study

• Published in: British Journal of Clinical Pharmacology 2021-04, Vol.87 (4), p.2111-2120
• Main Authors: Nørgård, Bente Mertz, Nielsen, Jan, Knudsen, Torben, Nielsen, Rasmus Gaardskær, Larsen, Michael Due, Jølving, Line Riis, Kjeldsen, Jens
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; biologics; Case-Control Studies; clinical epidemiology; COVID-19 - diagnosis; COVID-19 - epidemiology; COVID-19 - immunology; COVID‐19; Denmark - epidemiology; Female; Hospitalization; Humans; Immunocompromised Host; Immunologic Factors - adverse effects; immunosuppressive; Immunosuppressive Agents - adverse effects; Male; Middle Aged; pharmacoepidemiology; Registries; Risk Assessment; Risk Factors; thiopurines; Time Factors; Young Adult
• ISSN: 0306-5251; 1365-2125
• DOI: 10.1111/bcp.14622

Aims In the Danish population, we examined whether patients treated with thiopurines, methotrexate, systemic corticosteroids, anti‐tumour necrosis factor (TNF)‐α agents, anti‐interleukin therapeutic agents, selective immunosuppressive agents and cyclosporine/tacrolimus had an increased risk of hospitalization for COVID‐ 19, compared to the background population. Methods A nationwide cohort study including all people alive in Denmark on 1 March 2020. Exposed patients constituted those exposed to thiopurines (n = 5484), methotrexate (n = 17 977), systemic corticosteroids (n = 55 868), anti‐TNF‐α agents (n = 17 857), anti‐interleukin therapeutic agents (n = 3744), selective immunosuppressive agents (n = 3026) and cyclosporine/tacrolimus (n = 1143) in a period of 12 months prior to 1 March 2020 (estimated time of outbreak in Denmark). We estimated the adjusted risk of hospitalization for COVID‐19 for patients treated with the above‐mentioned categories of medications, compared to the rest of the population. Results The adjusted odds ratios of hospitalization in patients treated with corticosteroids and cyclosporine/tacrolimus were 1.64 (95% confidence interval [CI] 1.35 to 2.00) and 4.75 (95% CI 1.96 to 11.49), respectively. The risks of hospitalization in patients treated with thiopurines, methotrexate, and anti‐TNF‐α agents, were 1.93 (95% CI 0.91 to 4.08), 0.74 (95% CI 0.43 to 1.28), 1.00 (95% CI 0.52 to 1.94), respectively. The number of outcomes in patients treated with anti‐interleukin therapeutic agents and selective immunosuppressive agents was too small for analysis. Conclusion Patients treated with systemic corticosteroids and cyclosporine/tacrolimus had a significantly increased risk of being hospitalized for COVID‐19. Our study does not uncover whether the increased risk is related to the drug itself, the underlying condition for which the patient is treated or other factors.