Routine Use of Immunosuppressants is Associated with Mortality in Hospitalised Patients with Covid-19

Background: Whilst there has been some literature on impact of SAR viruses in severely immunosuppressed, less is known about the link between general usage of immunosuppressants and outcome in COVID-19. Consequently, guidelines on their use vary depending on specific patient populations. Methods: The study population was drawn from the COPE Study (COVID-19 in Older People), a multicentre observational cohort study, carried out in ten UK and one Italian hospitals. Data were collected between 27th February and 28th April by trained data collectors and included all non-selected consecutive admissions with Covid-19. Type and dosage of immunosuppressant use were collected along with other covariate data. The primary outcome was the time-to-mortality from the date of admission (or) date of diagnosis, if diagnosis was five or more days after admission. Secondary outcomes were Day-7 mortality and the time-to-discharge (described as the length of stay). Data were analysed with a mixed-effects, Cox proportional hazards and Logistic regression models using non-users of immunosuppressants as the reference group. Results: 1184 patients were eligible to be included. The median (IQR) age was 74(63-81) and 676(58%) were male, and 299(25.3%) died in hospital. Most patients exhibited at least one comorbidity, and 113(~10%) were on immunosuppressants. We found that any immunosuppressant use was associated with increased mortality: aHR 1.89,95%CI:1.31,2.71 (time to mortality) and aOR 1.90,95%CI:1.16-3.10 (7-day mortality). There appeared to be a direct and linear dose-response relationship regardless of the agent used. Conclusion: Low threshold to seek medical advice and close monitoring of worsening symptoms should be exercised in those who take immunosuppressants regardless of their indication.