Hospitalization for COVID-19 in patients treated with selected immunosuppressant and immunomodulating agents, compared to the general population: A Danish cohort study
Hospitalization for COVID-19 in patients treated with selected immunosuppressant and immunomodulating agents, compared to the general population: A Danish cohort study
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DOI：
10.1111/bcp.14622
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发表时间：
2020-12-02
影响因子：
3.4
通讯作者：
Kjeldsen, Jens
中科院分区：
文献类型：
--
作者：
Norgard, Bente Mertz;Nielsen, Jan;Kjeldsen, Jens
目的：在丹麦人群中，我们考察了与背景人群相比，接受硫嘌呤、甲氨蝶呤、全身性皮质类固醇、抗肿瘤坏死因子-α药物、抗白细胞介素类药物、选择性免疫抑制剂和环孢菌素/他克莫司治疗的患者是否因新冠肺炎住院的风险增加。暴露患者包括在2020年3月1日(丹麦估计暴发时间)前12个月内接触硫嘌呤(n=5484)、甲氨蝶呤(n=17977)、全身皮质类固醇(n=55868)、抗肿瘤坏死因子-α药物(n=17857)、抗白细胞介素类治疗药物(n=3744)、选择性免疫抑制剂(n=3026)和环孢菌素/他克莫司(n=1143)的患者。结果接受糖皮质激素和环孢素/他克莫司治疗的患者住院的调整优势比分别为1.64(95%可信区间1.35~2.00)和4.75(95%可信区间1.96~11.49)。接受硫嘌呤、甲氨蝶呤和抗肿瘤坏死因子-α药物治疗的患者住院的风险分别为1.93(95%CI 0.91~4.08)、0.74(95%CI 0.43~1.28)、1.00(95%CI 0.52~1.94)。结论全身糖皮质激素和环孢菌素/他克莫司联合治疗的患者因新冠肺炎住院的风险显著增加。我们的研究没有揭示风险增加是否与药物本身、患者接受治疗的潜在状况或其他因素有关。
Aims In the Danish population, we examined whether patients treated with thiopurines, methotrexate, systemic corticosteroids, anti-tumour necrosis factor (TNF)-alpha 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-alpha 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-alpha 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.