Prior immunosuppressive therapy is associated with mortality in COVID‐19 patients: A retrospective study of 835 patients

• Published in: Journal of Medical Virology 2021-10, Vol.93 (10), p.5768-5776
• Main Authors: Akama‐Garren, Elliot H., Li, Jonathan X.
• Format: Article
• Language: English
• Subjects: Age; Confidence intervals; Coronaviruses; COVID-19; Diagnosis; Fatalities; Health care facilities; Immunosuppression; Immunosuppressive agents; Inflammation; Laboratories; Leukocytes (neutrophilic); Lymphocytes; Markers; Mortality; Mycophenolic acid; Patients; Polymerase chain reaction; severity; Statistical analysis; steroid; Steroid hormones; Tacrolimus; Therapy; Viral diseases; Virology
• ISSN: 0146-6615; 1096-9071
• DOI: 10.1002/jmv.27105

Though it is widely believed that chronic immunosuppressive medications increase the severity of coronavirus disease 2019 (COVID‐19) illness, there is little data to support this. We performed a retrospective study of COVID‐19 positive patients diagnosed at a single academic medical center between March 10, 2020 and October 13, 2020. A total of 835 patients diagnosed with COVID‐19 by polymerase chain reaction were included (median age 64 years; 52% female). Of these, 46 (5.5%) had a prescription for an immunosuppressive therapy before diagnosis, most commonly oral steroids (20, 43%), mycophenolate (12, 26%), or tacrolimus (11, 24%). Patients on immunosuppressive therapy with COVID‐19 had increased mortality (30% vs. 17%, p = 0.036; odds ratio 2.1, 95% confidence interval 1.11–4.04), which remained significant (p = 0.040) after performing multivariate logistic regression controlling for gender, age, race, and comorbidity status. Laboratory markers of inflammation were uniformly elevated in both patients on or not on immunosuppressive therapies who died, but lymphocytes and neutrophils were decreased in both COVID‐19 patients on immunosuppressive therapies who died and who remained alive. These findings demonstrate that COVID‐19 disease is more severe in patients taking prior immunosuppressive medications. This finding emphasizes the need for aggressive monitoring and supportive care for immunosuppressed patients who are diagnosed with COVID‐19. Highlights COVID‐19 patients on immunosuppression at the time of diagnosis have increased mortality. Laboratory markers of inflammation are elevated in severe COVID‐19 in both patients on and non on prior immunosuppression. Age is not associated with longer hospitalization in COVID‐19 patients on prior immunosuppression.