BOSTON — The risk of severe COVID-19 despite vaccination is substantial in patients taking immune-suppressive drugs, and their risk is much greater than patients with inflammatory diseases.
That’s according to a recent study in Implant Infectious Diseases, which pointed out, “Patients taking immune-suppressive drugs are at increased risk of severe coronavirus disease 2019 (COVID-19), not fully ameliorated by vaccination.”1
Researchers from the VA Boston Cooperative Studies Program assessed how clinical and demographic factors contributed to the risk of severe disease despite vaccination in patients taking immune-suppressive medications for solid organ transplantation (SOT). Those patients were compared to others with rheumatoid arthritis (RA), inflammatory bowel disease (IBD) or psoriasis.
The study team used VHA electronic health records to identify patients diagnosed with RA, IBD, psoriasis or SOT who had been vaccinated against severe acute respiratory syndrome coronavirus 2, were subsequently infected and had received immune-suppressive drugs within 3 months before infection.
Researchers employed multivariable logistic regression to assess the association of severe—defined as hypoxemia, mechanical ventilation, dexamethasone use or death—vs. nonsevere COVID-19 with the use of immune-suppressive and antiviral drugs and clinical covariates.
Their results indicated that severe COVID-19 was more common in patients with SOT (230/1011, 22.7%) than RA (173/1355, 12.8%), IBD (51/742, 6.9%) or psoriasis (82/1125, 7.3%).
“Age was strongly associated with severe COVID-19, adjusted odds’ ratio (aOR) of 1.04 (CI 1.03-1.05) per year,” the authors pointed out. “Comorbidities indicating chronic brain, heart, lung, or kidney damage were also associated with severity, aOR 1.35-2.38.”
While the use of glucocorticoids was associated with increased risk (aOR 1.66, CI 1.39-2.18), treatment with antivirals was associated with reduced severity, for example, aOR 0.28 (CI 0.13-0.62) for nirmatrelvir/ritonavir.
“The risk of severe COVID-19 despite vaccination is substantial in patients taking immune-suppressive drugs, more so in patients with SOT than in patients with inflammatory diseases,” the researchers concluded. “Age and severe comorbidities contribute to risk, as in the general population. Oral antivirals were very beneficial, but not widely used.”
- Anand ST, Vo AD, La J, Brophy M, et. al. Risk of severe coronavirus disease 2019 despite vaccination in patients requiring treatment with immune-suppressive drugs: A nationwide cohort study of US Veterans. Transpl Infect Dis. 2023 Nov 15:e14168. doi: 10.1111/tid.14168. Epub ahead of print. PMID: 37966134.
