Clinical outcomes of immunomodulation therapy in immunocompromised patients with severe Covid-19 and high oxygen requirement

Avigayil Goldstein, Ami Neuberger, Yazeed Qassem Darawsha, Khetam Hussein, Tali Shafat, Daniel Grupel, Jacob strahilevitz, Sarah Israel, Ariel Weil, Ronen Ben-Ami, Meital Elbaz, Ronza Najjar-Debbiny, Jihad Bishara, Amir Shlomai, Michal Landes

Research output: Contribution to journalArticlepeer-review

Abstract

Covid-19 disease is implicated in increased mortality among immunocompromised patients. The JAK inhibitor, baricitinib (bar), or the IL-6 inhibitor, tocilizumab (toc), demonstrated a survival benefit in patients with severe disease.However, evidence supporting their use in immunocompromised patients with severe Covid-19 is scarce.We aimed to assess clinical outcomes of bar/toc treatment in immunocompromised patients. A multi-center registry of consecutive immunocompromised patients hospitalized due to severe Covid-19 during the Omicron variant dominance period. After excluding patients who did not require high oxygen supply, patients treated with bar/toc were compared to patients treated by standard of care (SOC). Primary outcome was in hospital mortality. Secondary outcomes were 30 and 60 day mortality, super-infection and thromboembolic events. Among an overall 228 immunocompromised patients hospitalized in six Israeli hospitals with severe Covid-19, 112 patients required high oxygen support, of whom 48 (43%) were treated with bar/toc. In-hospital mortality rates were exceptionally high and did not significantly differ between bar/toc and SOC treated patients (62.5% vs. 64.1%, p = 1.0). A logistic regression analysis revealed that advanced age and incomplete vaccination were predictors of in-hospital mortality. Patients treated with bar/toc had no excess of suspected super-infection (62.8% vs. 60.7%, p = 0.84) or thromboembolic events (8.3% vs 3.1%, p = 0.39). In immunocompromised patients with severe Covid-19 and a high oxygen demand, bar/toc therapy was not associated with reduced mortality or with a higher rate of associated complications, compared to SOC. Larger prospective studies should better address efficacy and safety.

Original languageEnglish
Article number16985
JournalScientific Reports
Volume14
Issue number1
DOIs
StatePublished - 1 Dec 2024

Keywords

  • Covid-19
  • Critical disease
  • Immunomodulatory treatment
  • Immunosuppressed patients

ASJC Scopus subject areas

  • General

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