Outcome of COVID‐19 in Patients With Autoimmune Hepatitis: An International Multicenter Study

Abstract

Background: Data regarding outcome of Coronavirus disease 2019 in patients with autoimmune hepatitis (AIH) are lacking. Patients and methods:We performed a retrospective study on AIH patients with COVID-19 from 34 centres in Europe and the Americas. We analyzed factors associated with severe COVID-19 outcomes defined as the need for mechanical ventilation, intensive care admission, and/or death. The outcomes of patients with AIH were compared to a propensity-score matched cohort of non-AIH patients with chronic liver diseases (CLD) and COVID-19. The frequency and clinical significance of new-onset liver injury (alanine aminotransferase>2xupper limit of normal) during COVID-19 was also evaluated. Accepted ArticleThis article is protected by copyright. All rights reserved Results: We included 110 AIH patients (80%,female) with a median age of 49 (range:18-85) years at COVID-19 diagnosis. New-onset liver injury was observed in 37.1% (33/89) of the patients. Use of antivirals was associated with liver injury (p=0.041; odds ratio (OR) 3.36[1.05-10.78]) while continued immunosuppression during COVID-19 was associated with a lower rate of liver injury (p=0.009; OR 0.26[0.09-0.71]). The rates of severe ) and allcause mortality (10% vs 11.5%; p=0.852) were not different between AIH and non-AIH CLD.Cirrhosis was an independent predictor of severe COVID-19 in patients with AIH (p<0.001;). Continuation of immunosuppression or presence of liver injury during COVID-19 was not associated with severe COVID-19.Conclusions: This international, multi-center study reveals that patients with AIH were not at risk for worse outcomes with COVID-19 than other causes of CLD. Cirrhosis was the strongest predictor for severe COVID-19 in AIH patients. Maintenance of immunosuppression during COVID-19 was not associated with increased risk for severe COVID-19, but did lower the risk for new-onset liver injury during COVID-19.

Impact of COVID-19 on liver transplant recipients–A systematic review and meta-analysis

“…Immunosuppressive drugs, which alter the immune status and suppress the cytokine storms, have been tried in non-SOT COVID-19 infected patients with limited success. Furthermore, autoimmune hepatitis (non-LT) patients infected with SARS-CoV-2 are protected from liver injury when immunosuppression is continued [51,52]. However, it is currently recommended to lower the overall immunosuppression (especially anti-metabolites) in LT patients infected with COVID-19, similar to managing infections in transplant recipients to reduce the risk of superinfection [11,53].…”

SARS-CoV-2-specific immunity in immunosuppressed COVID-19 convalescents with autoimmune hepatitis

“…We read with interest the article “SARS-CoV-2 infection in patients with autoimmune Hepatitis” by Marjot et al [ 1 ] recently published in the Journal of hepatology. While immunosuppressive therapy for autoimmune hepatitis (AIH) had no negative impact on the immediate outcome of COVID-19 [ [1] , [2] , [3] ], the question remained, whether COVID-19 convalescents immunosuppressed for AIH (AIH-Con) are protected from a SARS-CoV-2 reinfection as non-immunosuppressed convalescents (non-IS-Con).…”

“…Similar findings of a slightly reduced humoral but otherwise robust cellular immunity against SARS-CoV-2 have been reported for liver transplant recipients (LTR), who usually had a much stronger immunosuppression [ [5] , [6] , [7] ]. LTR did not have increased COVID-19 mortality similar to AIH patients [ [1] , [2] , [3] , 8 , 9 ], while association of COVID-19 disease course with intake of mycophenolate and tacrolimus was ambiguous in two LTR studies [ 8 , 9 ]. In the light of these recent studies from more immunosuppressed LTR a comparable immunity against SARS-CoV-2 in AIH-Con is not surprising but reassuring.…”

Special Considerations in the Management of Autoimmune Hepatitis in COVID-19 Hotspots: A Review

“…The consistent findings across both the studies was that there is no increase in severity of COVID-19 infection across patients with AIH compared to other etiologies of chronic liver disease. 33,34 Presence of cirrhosis, particularly Child-C disease, was the most significant factor of poor outcomes in these patients. 34 New-onset liver injury was seen in one-third of the patients with AIH after COVID-19 in one study.…”