COVID-19 risks and outcomes for those taking immune suppressant medications, organ transplant recipients, and persons with autoimmune rheumatic disease

 

Scientific Study Title:

Risk and outcome of COVID-19 in patients exposed to immunosuppressive and immunomodulatory agents (IIA) in British Columbia. A population-based study.

 

Study Start Date:

July 2020

 

End Date:

June 2021

 

Why Did We Do This Research?

Patients with autoimmune rheumatic diseases, organ transplant recipients, or those who take medications that suppress or modulate their immune system often worry about their risk of severe COVID-19 outcomes. These factors may leave these groups more vulnerable to infections, raising concerns about higher risks of hospitalization, severe complications, or death.

Although COVID-19 cases in British Columbia (BC) are currently declining, seasonal waves or new variants could cause future surges. To prepare, it is important that we understand which groups of people are at higher risk for severe outcomes from COVID-19 and how certain medications and/or conditions affect the severity of COVID-19.

 

What Did We Do?

We conducted two studies, using administrative health records from British Columbia.

Study 1:  We focused on people using medications called immunosuppressive and immunomodulatory agents (IIAs), such as certain drugs for autoimmune rheumatic diseases. We analyzed how these medications influenced the risk of severe COVID-19 outcomes like hospitalization, ICU admission, or death. This study included records of more than 147,000 patients. 

Study 2:  We looked at people with autoimmune rheumatic diseases and organ transplant recipients to understand how their risk compared to others without these conditions. Records of 6279 patients with ARDs and 222 transplant recipients were included and compared with those from the general population.

Both studies used data from February 2020 to August 2021 and applied statistical methods to account for differences between patients (such as age or pre-existing health conditions).

What Did We Find?

Study 1: We found that taking mycophenolate mofetil was associated with a higher risk of being hospitalized or needing ICU care for COVID-19. We also found that glucocorticoids, another type of immune-modulating drug, were linked to a higher risk of death within 60 days of a positive COVID-19 test, in addition to a higher risk of hospitalization and ICU admission.

Study 2: People with autoimmune rheumatic diseases were more likely to be hospitalized, need ICU care, or require invasive ventilation compared to others without these conditions. Among the autoimmune rheumatic diseases, conditions like vasculitis and ankylosing spondylitis showed particularly high risks of severe outcomes. Organ transplant recipients faced the highest risks, with over 10 times the likelihood of hospitalization and significantly higher risks of ICU admission and death compared to the general population.

 

What Does This Mean?

Both studies highlight the increased risks of severe COVID-19 outcomes for certain groups:

  • People taking specific immune-modulating medications (like mycophenolate mofetil and glucocorticoids).
  • Patients with autoimmune diseases or those who have had organ transplants.

These findings suggest that healthcare providers should prioritize these groups for strategies to reduce risks, including booster vaccinations, early diagnosis, and prompt treatment for COVID-19.

Infographic 

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The Research Team

​Principal Investigator: 

J. Antonio Avina-Zubieta, MD, MSc, PhD, FRCPC, Senior Scientist, Arthritis Research Canada; Associate Professor of Medicine, Division of Rheumatology, Department of Medicine, University of British Columbia.

 

Co-Investigators:

Jacek Kopec, MD, MSc, PhD, Senior Scientist Emeritus, Epidemiology, Arthritis Research Canada (University of British Columbia)

Diane Lacaille, MDCM, MHSc, FRCPC, Scientific Director, Arthritis Research Canada (University of British Columbia)

Hui Xie, BSc, MS, PhD, Research Scientist, Biostatistics, Arthritis Research Canada (Simon Fraser University)

Jonathan Loree, MD, MS, FRCPC (University of British Columbia)

 

Knowledge Translation Collaborator:

Alison Hoens, MSc, BScPT, Affiliate Scientist – Knowledge Broker, Arthritis Research Canada (University of British Columbia)

 

Research Staff:

Shelby Marozoff, MSc, Research Coordinator, Arthritis Research Canada

Dami Ojo, B.Pharm, MPH, Research Assistant, Arthritis Research Canada

 

Patient Partners:

Bonnie Corradetti

Peter Malone

Cheryl L. Koehn

Philippa Mennell

 

Funding Agency:

Michael Smith Foundation for Health Research

 

Related Publications:

  • Marozoff S, Tan J, Lu N, et al. Effect of Immunosuppressive or Immunomodulatory Agents on Severe COVID-19 Outcomes: A Population-Based Cohort Study. ACR Open Rheumatol. 2023;5(12):685-693. doi:10.1002/acr2.11620
  • Marozoff S, Lu N, Loree JM, et al. Severe COVID-19 outcomes among patients with autoimmune rheumatic diseases or transplantation: a population-based matched cohort study. BMJ Open 2022;12:doi: 10.1136/bmjopen-2022-062404