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Assessing the associations between immunosuppressant use and COVID-19 severity in patients with autoimmune hepatitis

Year: 2026
Type: article
Study design: Observational Study
Abstract: BACKGROUND Due to immunosuppression (IS) use, patients with autoimmune hepatitis (AIH) may be at high risk for poor coronavirus disease 2019 (COVID-19) outcomes. AIM To investigate the associations between IS type and COVID-19 severity in AIH patients using the National Clinical Cohort Collaborative (N3C) COVID enclave. METHODS We identified all AIH patients with COVID-19 in the N3C COVID enclave. We used adjusted logistic regressions to determine associations between IS type and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. We used Cox models to determine associations between IS type and all-cause mortality in the subset of AIH patients infected with SARS-CoV-2. RESULTS Of 15187 AIH patients, 5106 (33%) had IS exposure, and 1604 (11%) tested positive for SARS-CoV-2 during the study period from March 2020 through March 2025. There was an association with prednisone [odds ratio (OR): 0.81, 95%CI: 0.65-0.99, P = 0.04] exposure and SARS-CoV-2 test positivity. For interactions between different IS combinations and SARS-CoV-2 test positivity in the overall cohort, budesonide and azathioprine (OR: 1.88, 95%CI: 1.02-3.44, P = 0.04) and prednisone and tacrolimus interactions (OR: 1.99, 95%CI: 1.14-3.53, P = 0.02) showed significant associations. Within the subgroup finding of patients with full model for end stage liver disease data, budesonide and azathioprine interaction (OR: 4.44, 95%CI: 1.29-16.72, P = 0.02) also had a significant association. In our adjusted Cox regressions and corresponding subgroup analysis, we found no specific IS type that was statistically significant in association with all-cause mortality. CONCLUSION Prednisone exposure was negatively associated, and statistically significant IS interactions were positively associated with testing positive for SARS-CoV-2. Further work involves determining the impact of vaccinations and advances in COVID-19 treatment on outcomes in this population.
DOI: 10.4254/wjh.v18.i2.114481
Language: English
Field: Medicine
Open Access status: diamond
Funders: Bill and Melinda Gates Foundation, Gilead Sciences, University of Southern California, Brown University, University of Nebraska Medical Center, Vanderbilt University, University of Miami, University of Pennsylvania, Ohio State University, Emory University, Tufts Medical Center, NYU Langone Medical Center, University of Wisconsin-Madison, Northwestern University, George Washington University, Wake Forest University, Cincinnati Children's Hospital Medical Center, Children's Hospital Colorado, Vanderbilt Institute for Clinical and Translational Research, University of Chicago, University of Michigan, Harvard Catalyst, University of Utah, University of Washington, University of Texas Medical Branch, Tulane University, Johns Hopkins University, University of Pittsburgh, University of Oklahoma, Institute for Translational Medicine and Therapeutics, Institute of Clinical and Translational Sciences, Georgetown University, University of Rochester, University of Cincinnati, Case Western Reserve University, Dartmouth College, Pennsylvania State University, Carilion Clinic, Rush University, University of South Carolina, Aurora Health Care, Virginia Commonwealth University, Southern California Clinical and Translational Science Institute, West Virginia University, Montana State University, MedStar Health Research Institute, Georgetown-Howard Universities Center for Clinical and Translational Science, NorthShore University HealthSystem, Vanderbilt University Medical Center, Institute of Translational Health Sciences, Georgia Clinical and Translational Science Alliance, Penn State Clinical and Translational Science Institute, Children's National Hospital, Louisiana Clinical and Translational Science Center, Ochsner Health, West Virginia Clinical and Translational Science Institute, Astellas Pharma, Stony Brook University, National Institutes of Health, University of Illinois at Urbana-Champaign, Institute for Clinical and Translational Research, University of Wisconsin, Madison, University of California, Los Angeles, Weill Cornell Medical College, University of California, San Diego, University of Oklahoma Health Sciences Center, University of California, San Francisco, University at Buffalo, University of California, Irvine, Center for Clinical and Translational Research, University of Colorado Denver, Center for Clinical and Translational Science, University of Massachusetts, Center for Clinical and Translational Science, Mayo Clinic, Center for Clinical and Translational Sciences, University of Texas Health Science Center at Houston, Irving Medical Center, Columbia University, Translational Research Institute, University of Arkansas for Medical Sciences, South Carolina Clinical and Translational Research Institute, Medical University of South Carolina, Clinical and Translational Science Institute, Boston University, National Institute of General Medical Sciences, National Institute of Diabetes and Digestive and Kidney Diseases, National Center for Advancing Translational Sciences, Colorado Clinical and Translational Sciences Institute, Institute for Clinical and Translational Science, University of California, Irvine, Wake Forest Clinical and Translational Science Institute, Wake Forest School of Medicine, Accelerated Innovation Research Initiative Turning Top Science and Ideas into High-Impact Values
Awards: G1003362385, G1034546755, G1101846420, G1110702752, G112449207, G1133076894, G1133842343, G1144050223, G115506582, G1172658771, G1198907661, G1426198371, G156123175, G1576582908, G1599055349, G1679780777, G1699415014, G171052541, G1717162763, G1756254663, G1773452051, G180476886, G1838118559, G1843193268, G1843992630, G1859754121, G1862468807, G196810821, G2008237588, G2032961523, G2049072053, G2101559773, G210617772, G2118698080, G213118816, G2152875133, G216896791, G2173499975, G2190116832, G2191929784, G2202983096, G2209306964, G2228636686, G2244966566, G2266444343, G2272810715, G2285413653, G2294136274, G235420648, G235943272, G237123860, G2388603646, G2490806176, G2508192175, G2529322290, G2592540264, G2610614086, G2615776415, G2635992203, G2714998049, G2740763107, G274916466, G2762714575, G2824222223, Center for Clinical and Translational Science, G2922236389, G2928778974, G297095765, G2985381359, Stanford Center for Clinical & Translational Education and Research (Spectrum), G3015141988, G3075846822, G3137464953, G329278553, G343705321, G3439874718, G3455473179, G3534013791, G3667826151, G3797236039, Institute for Clinical and Translational Science, Tufts Clinical and Translational Science Institute, G3999804545, G4045563614, G4091522973, G4159580532, G4410787187, G4411448324, G467313275, G471519714, G476308836, G477853788, Northwestern University Clinical and Translational Science Institute (NUCATS), G4811095511, G4823677270, G4851974581, G4852991764, G486457145, G4900725235, G4924162002, G4925418384, G4950870472, G5031973872, G5049613280, G5059334661, G5086723997, G5159529264, G5258278944, G5286663980, G5316515788, G5352274017, G536197267, G5382207646, G5385890486, G5409860367, G5430408733, G5514976981, G5555614831, G5619247364, G5627382572, G572024221, G584478153, G5849810213, Expanding Translational Research in Arkansas, Utah Center for Clinical and Translational Science, G6036981074, G6090519289, G6107751520, G614564937, G625544220, American Indian - Alaska Native Clinical and Translational Research Center (AI-AN CTRC), G6523867696, G6576913434, North Carolina Translational and Clinical Science Institute (NC TraCS), Sage Bionetworks - to evaluate the signs and symptoms of COVID-19 in a data-consortium approach to inform better clinical decision making for diagnosis, G6675941278, G6720719670, G687203789, G691201058, G6979210571, G707880362, G713621388, G7137449453, G7157803174, G7199445640, Hispanic Alliance for Clinical and Translational Research (Alliance), G7406577712, G7473568262, G761346317, Clinical and Translational Science Institute at Childrens National, G7672581523, G7695494419, G7707125228, G7768549844, G7818101325, Clinical and Translational Science Award, Johns Hopkins Institute for Clinical and Translational Research, G7944486712, G797306165, G8013765, G8021374757, G8031621368, Colorado Clinical and Transational Sciences Institute, G8343818084, G836659948, G8536079613, G860365715, G876475942, G884562342, G8908676624, G9000001345, G9000002797, G9000004866, G9000005776, G9000006405, G9000009221, G9000010133, G9000013477, G9000025022, G9000027836, G9000028856, G9000030090, G9000031392, G9000032014, G9000037373, G9000037442, G9000038858, G9000039947, G9000043450, G9000046174, G9000047280, G9000049577, G9000054231, G9000054552, G9000057631, G9000062576, G9000065669, G9000066888, G9000068060, G9000068634, G9000072794, G9000073712, G9000076473, G9000082861, G9000099446, Frontiers Clinical and Translational Science Institute at the University of Kansas, G9000131833, G9000133327, G9000146461, G9000155184, G9000169037, G9000170389, G9000170742, G9000174002, G9000203384, G9000206034, G9000222291, G9000236242, G9000330694, University of Pittsburgh Clinical and Translational Science Institute, Mayo Clinic Center for Clinical and Translational Science (CCaTS), A pragmatic RCT to evaluate the effect of CirrhosisRx, a novel clinical decision support system, versus usual care on guideline-adherence and clinical outcomes for patients with cirrhosis, Kentucky Center for Clinical and Translational Science, Developing, Demonstrating, and Disseminating Innovative Programs to Achieve Translational Success, Clinical and Translational Science Institute, UTMB Clinical and Translational Science Award, G94668252, G95160140
OpenAlex ID: W7128616512
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