Immunosuppressive drugs leading to higher ventilation & deaths among COVID-19 patients? Here’s what Lancet study suggests

Immuno-suppressants and COVID-19: Immuno-suppressed people are not more likely to die due to COVID-19, nor are they at a higher risk of ventilation, as compared to those who do not take immunosuppressants, a new Lancet study has found. The study, which was published in The Lancet Rheumatology journal and was accessed by Financial Express Online, said that while previous studies had determined that patients suffering from autoimmune diseases were more like to contract COVID-19 infection, there were not any conclusive studies on the deaths or invasive ventilation reported among such patients. The study, therefore, analysed the health records of a whopping 2.22 lakh adults in the US who were hospitalised between January 2020 and June 2021. Of these, nearly 16,500 had been taking immunosuppressants before they were hospitalised.

The study divided immunosuppressive medications into several classes and found that each of the drug classes was either associated with reduced invasive mechanical ventilation or no effect at all, which means that none of the drug classes were associated with increased invasive ventilation. Meanwhile, the drug class of JAK inhibitors was found to be associated with a significant decrease in cases of in-hospital deaths. On the other hand, Rituximab, when taken for rheumatological conditions or as a cancer therapy, led to an increase in risk of in-hospital deaths. Other than that, no drugs led to a significant association with increase in in-hospital deaths, the study found. “Although not statistically significant, the effect size suggests a potentially elevated risk of death for people with anthracycline prescription,” the paper added.

The paper said that even though the cases related to COVID-19 seem to be on a decline, it is still an ongoing pandemic and therefore, there are some important questions that need to be answered. “In this analysis of more than 2,20,000 adults hospitalised with COVID-19, there was no discernible increased risk of invasive mechanical ventilation or in-hospital death with most of the therapies we examined,” the paper said. These findings are important because these therapies are commonly used among patients across the globe, and there are many questions around how these therapies and the drugs involved can impact their health.

The findings of this study can help doctors figure out treatments for people with comorbidities while keeping in mind the ongoing risk of the coronavirus pandemic. Since these immunosuppressive drugs have not shown to lead to any major increase in the cases of invasive ventilation or, for most drugs, in cases of in-hospital deaths, this information can help doctors ascertain which immunosuppressants they can administer to patients so that they do not lead to adverse effects in case a patients ends up contracting COVID-19 and requires hospitalisation. This also sheds light on the fact that given the current pandemic, patients who have otherwise been taking Rituximab either as a cancer therapy or for rheumatological conditions need to discuss alternatives with their doctors.

However, while the study has looked at hospitalised cases of coronavirus and how it matches with immunosuppressants, there is also a need for in-depth study regarding the link between these drugs and the various COVID-19 vaccines. So far, as per the UK’s NHS, “immunosuppressed patients, due to disease or treatment are an ‘at-risk’ group (previous termed ‘clinically extremely vulnerable’) and should be vaccinated against COVID-19”. It also added that as per the patient group detection reports for various vaccines, “there are no groups of potentially immunosuppressed patients that should be excluded from receiving the vaccine based on their treatment or disease alone. It is, however, noted that some immunosuppressed patients may have a suboptimal response to the vaccine and should therefore continue to avoid exposure unless they are advised otherwise by their doctor”.

This, however, does need to be looked at in-depth in a similar kind of study so that the level of protection for immuno-suppressed patients with COVID-19 can be determined and better alternatives can be looked at or developed for such patients.