Does Long-Term Use of Immunosuppressive Medications Inform In-Hospital COVID-19 Outcomes?

Most patients with RA are taking multiple medications, which must be managed during the perioperative period.
Most patients with RA are taking multiple medications, which must be managed during the perioperative period.
Do patients who receive treatment with long-term immunosuppressive medications have worse outcomes when hospitalized with COVID-19?

Individuals receiving treatment with long-term immunosuppressive medications, except rituximab, and hospitalized for COVID-19 were not found to have an increased risk for invasive mechanical ventilation (IMV) or in-hospital death, according to study results published in Lancet Rheumatology.

The researchers of the current study sought to explore whether individuals receiving treatment with long-term immunosuppressive therapy have worse outcomes when hospitalized with COVID-19.

A retrospective cohort study was conducted using data from the National COVID Cohort Collaborative (N3C), the largest US electronic health record repository of hospitalized patients with COVID-19, between January 1, 2020, and June 11, 2021, within 42 health systems. In addition to overall patient risk, researchers assessed whether the therapeutic class of immunosuppressive medication used was associated with the need for IMV or risk for death.

Of a total of 231,830 potentially eligible patients in the N3C repository hospitalized with confirmed COVID-19 during the study period, 222,575 met the study inclusion criteria. The mean participant age was 59±19 years; half of the patients were men. The most common comorbidities included diabetes (23%), pulmonary disease (17%), and kidney disease (13%). Overall, 16,494 (7%) patients were receiving immunosuppressive therapy for such conditions such as rheumatologic disease (33%), solid organ transplantation (26%), and cancer (22%).

According to unadjusted analyses, patients receiving vs not receiving immunosuppressive medications were at a higher risk for IMV (9% vs 6%; hazard ratio [HR], 1.36; 95% CI, 1.29-1.43) and in-hospital death (14% vs 9%; HR, 1.05; 95% CI, 1.01-1.10). In the propensity score-matched cohort, treatment with immunosuppressive medications vs no immunosuppression therapy was associated with a decreased risk for IMV (8% vs 9%; HR, 0.89; 95% CI, 0.83-0.96). In addition, researchers did not observe a link between long-term immunosuppression and risk for in-hospital death (14% vs 12%; HR, 0.97; 95% CI, 0.91-1.02).

Overall, none of the 15 medication classes analyzed were associated with an increased risk for IMV.

Although no statistically significant association was demonstrated between most of the medications examined and the occurrence of in-hospital deaths, an increased risk was reported with rituximab used for rheumatologic conditions (HR, 1.72; 95% CI, 1.10-2.69) and cancer treatment (HR, 2.57; 95% CI, 1.86-3.56).

Results of the study were largely consistent across subgroup analyses that accounted for race and ethnicity or sex, as well as across sensitivity analyses in which definitions for exposure, covariates, and outcomes varied.

The researchers concluded, “This information could be useful not only to guide future research, but also to clinicians and patients navigating treatment decisions together.”

Disclosure: Some of the study authors have declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures. 


Andersen KM, Bates BA, Rashidi ES, et al; National COVID Cohort Collaborative Consortium. Long-term use of immunosuppressive medicines and in-hospital COVID-19 outcomes: a retrospective cohort study using data from the National COVID Cohort Collaborative. Lancet Rheumatol. 2022;4(1):e33-e41. doi:10.1016/S2665-9913(21)00325-8

This article originally appeared on Rheumatology Advisor