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People Taking High-Dose Glucocorticoids Have a Worse Prognosis for COVID-19

New study assesses disease outcomes among people on different immunosuppressive treatments

28.06.2022
Photo: Francisco Àvia / Hospital Clínic

Severe COVID-19 is characterised by an excessive inflammatory response - it is the overproduction of inflammatory mediators (cytokines) that causes organ damage, not the virus itself. Thus, glucocorticoids that have been shown to reduce COVID-19 mortality due to their immunosuppressive activity

"Studies conducted so far in patients receiving chronic immunosuppressive treatments prior to COVID-19 diagnosis are conflicting - some find an increased risk of hospitalisation while others find no effect or a protective effect," says Ana Requena, ISGlobal researcher and study coordinator.

In this study, the research team evaluated whether people who routinely take an immunosuppressive treatment (e.g. transplant recipients or people with autoimmune diseases) are more - or less - protected against severe disease or death if they become infected. The study included people diagnosed with COVID-19 and who also had a disease that may be amenable to immunosuppressive treatment. They classified the patients into four broad groups, according to the drug they were taking: high-dose glucocorticoids, monoclonal antibodies directed against B cells (to treat leukaemia and some autoimmune diseases), any other immunosuppressive drug, and all the rest.

The results, obtained from more than 1,000 patients admitted to Karolinska Hospital in Sweden, show that anticancer and other immunosuppressive drugs were not associated with differences in symptom severity or mortality from COVID-19. But patients taking high doses of glucocorticoids such as prednisolone (>20 mg per day) had an increased risk of hospitalisation, heart or lung problems, and COVID-19 mortality.

"This association between chronic glucocorticoid exposure and worse COVID-19 outcome could be because the T-cell response is suppressed and therefore it is more difficult to recognise early signs of infection," explains Requena. "But it may also be because such patients have an underlying disease that puts them at higher risk," she adds.

The authors point out that further studies are needed to distinguish between the effect of health status in these patients, and the effect of taking different doses of glucocorticoids, on the prognosis of COVID-19.

Reference

Brodin R, van der Werff SD, Hedberg P, Färnert A, Nauclér P, Bergman P, Requena-Méndez A. The association between pre-exposure to glucocorticoids and other immunosuppressant drugs with severe COVID-19 outcomes. Clin Microbiol Infect. 2022 May 26;S1198-743X(22)00270-1. doi: 10.1016/j.cmi.2022.05.014.