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Influence of chronic use of corticosteroids and calcineurin inhibitors on COVID-19 clinical outcomes: analysis of a nationwide registry.

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2021-12-28

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Calderón-Parra, Jorge
Cuervas-Mons, Valentín
Moreno-Torres, Victor
Rubio-Rivas, Manuel
Blas, Paloma Agudo-de
Pinilla-Llorente, Blanca
Helguera-Amezua, Cristina
Jiménez-García, Nicolás
Pesqueira-Fontan, Paula-María
Méndez-Bailón, Manuel

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Abstract

The aim of this study was to analyze whether subgroups of immunosuppressive (IS) medications conferred different outcomes in COVID-19. The study involved a multicenter retrospective cohort of consecutive immunosuppressed patients (ISPs) hospitalized with COVID-19 from March to July, 2020. The primary outcome was in-hospital mortality. A propensity score-matched (PSM) model comparing ISP and non-ISP was planned, as well as specific PSM models comparing individual IS medications associated with mortality. Out of 16 647 patients, 868 (5.2%) were on chronic IS therapy prior to admission and were considered ISPs. In the PSM model, ISPs had greater in-hospital mortality (OR 1.25, 95% CI 0.99-1.62), which was related to a worse outcome associated with chronic corticoids (OR 1.89, 95% CI 1.43-2.49). Other IS drugs had no repercussions with regard to mortality risk (including calcineurin inhibitors (CNI); OR 1.19, 95% CI 0.65-2.20). In the pre-planned specific PSM model involving patients on chronic IS treatment before admission, corticosteroids were associated with an increased risk of mortality (OR 2.34, 95% CI 1.43-3.82). Chronic IS therapies comprise a heterogeneous group of drugs with different risk profiles for severe COVID-19 and death. Chronic systemic corticosteroid therapy is associated with increased mortality. On the contrary, CNI and other IS treatments prior to admission do not seem to convey different outcomes.

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Adrenal Cortex Hormones
Calcineurin Inhibitors
Hospital Mortality
Humans
Registries
Retrospective Studies
SARS-CoV-2
COVID-19 Drug Treatment

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COVID-19, autoimmune diseases, immune-mediated inflammatory diseases, immunocompromised host, prognosis factors, solid organ transplantation

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