COVID-19 Outcomes No Worse for Patients on Most Immunosuppressive Medicines

Results from a recent study indicate that patients being treated with immunosuppressive therapies (rheumatological, antineoplastic, or antimetabolite) were at no increased risk of mechanical ventilation or in-hospital death when hospitalized for COVID-19, except for those being treated with rituximab.

Using data from the National COVID Cohort Collaborative (N3C), researchers compared adults with immunosuppressive medications used before admission to adults without long-term immunosuppression. All patients involved had been hospitalized with confirmed or suspected COVID-19 in the US between January 1, 2020, and June 11, 2021. Patients were considered immunosuppressed if they had exposure to rheumatological drugs, antimetabolite drugs, cancer therapies, rituximab, targeted cancer therapies, or oral glucocorticoids. Researchers considered immunosuppression overall, as well as 15 classes of medication and 3 broad indications for immunosuppressive medicines.

There were 222,575 patients included in the study (mean age 59 years, 111,296 or 50% male). Comorbidities included diabetes (23%), pulmonary disease (17%), and renal disease (13%). Of the patients, 16,494 (7%) had long-term immunosuppression with medications for diverse conditions, such as rheumatological disease (33%), solid organ transplant (26%), or cancer (22%). Researchers found that “in the propensity score matched cohort (including 12,841 immunosuppressed patients and 29,386 nonimmunosuppressed patients), immunosuppression was associated with a reduced risk of invasive ventilation (HR 0·89, 95% CI 0·83–0·96) and there was no overall association between long-term immunosuppression and the risk of in-hospital death.”

There was no association of increased risk of invasive mechanical ventilation with any of the 15 medication classes examined. While there was no statistically significant association between most drugs and in-hospital death, there was an increase found with rituximab for rheumatological disease (1·72, 1·10–2·69) and for cancer (2·57, 1·86–3·56).

Researchers added that these results “add to a growing body of evidence on the overall safety of most long-term immunosuppressive medications against the backdrop of continued COVID-19-related morbidity and mortality.”

—Allison Casey

Andersen KM, Bates BA, Rashidi ES, et al. Long-term use of immunosuppressive medicines and in-hospital COVID-19 outcomes: a retrospective cohort study using data from the National COVID Cohort Collaborative. Lancet Rheumotol. Published online first: November 2021.DOI: https://doi.org/10.1016/S2665-9913(21)00325-8