Hospitalization for COVID-19 in patients treated with selected immunosuppressant and immunomodulating agents, compared to the general population - a Danish cohort study.

Nørgård, Bente Mertz; Nielsen, Jan; Knudsen, Torben; Nielsen, Rasmus Gaardskaer; Larsen, Michael Due; Jølving, Line Riis; Kjeldsen, Jens

AIMS In the Danish population, we examined whether patients treated with thiopurines, methotrexate, systemic corticosteroids, anti-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 ANationwide cohort study including all people alive in Denmark by March 1, 2020. Exposed patients constituted those exposed to thiopurines (N=5,484), methotrexate (N=17,977), systemic corticosteroids (N=55,868), anti-TNF-α agents (N=17,857), anti-interleukin therapeutic agents (N=3,744), selective immunosuppressive agents (N=3,026), and cyclosporine/tacrolimus (N=1,143) in a period of 12 months prior to March 1, 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% 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. CONCLUSIONS 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.