Abstract
BACKGROUND: Due to immunosuppression (IS) use, patients with autoimmune hepatitis (AIH) may be at high risk for poor coronavirus disease 2019 (COVID-19) outcomes. AIM: To investigate the associations between IS type and COVID-19 severity in AIH patients using the National Clinical Cohort Collaborative (N3C) COVID enclave. METHODS: We identified all AIH patients with COVID-19 in the N3C COVID enclave. We used adjusted logistic regressions to determine associations between IS type and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. We used Cox models to determine associations between IS type and all-cause mortality in the subset of AIH patients infected with SARS-CoV-2. RESULTS: Of 15187 AIH patients, 5106 (33%) had IS exposure, and 1604 (11%) tested positive for SARS-CoV-2 during the study period from March 2020 through March 2025. There was an association with prednisone [odds ratio (OR): 0.81, 95%CI: 0.65-0.99, P = 0.04] exposure and SARS-CoV-2 test positivity. For interactions between different IS combinations and SARS-CoV-2 test positivity in the overall cohort, budesonide and azathioprine (OR: 1.88, 95%CI: 1.02-3.44, P = 0.04) and prednisone and tacrolimus interactions (OR: 1.99, 95%CI: 1.14-3.53, P = 0.02) showed significant associations. Within the subgroup finding of patients with full model for end stage liver disease data, budesonide and azathioprine interaction (OR: 4.44, 95%CI: 1.29-16.72, P = 0.02) also had a significant association. In our adjusted Cox regressions and corresponding subgroup analysis, we found no specific IS type that was statistically significant in association with all-cause mortality. CONCLUSION: Prednisone exposure was negatively associated, and statistically significant IS interactions were positively associated with testing positive for SARS-CoV-2. Further work involves determining the impact of vaccinations and advances in COVID-19 treatment on outcomes in this population.