Journal Article

Calcineurin Inhibitor-Based Immunosuppression and COVID-19: Results from a Multidisciplinary Cohort of Patients in Northern Italy

Oggionni, Tiberio, Bonetto, Valentina, Pelenghi, Stefano, Gregorini, Marilena, Biglia, Alessandro, Corsico, Angelo, Gnecchi, Massimiliano, Zanframundo, Giovanni, Turco, Annalisa, Rampino, Teresa, Cavagna, Lorenzo, Vancheri, Carlo, Pellegrini, Carlo, Bertani, Alessandro, Zuccaro, Valentina, Vitulo, Patrizio, Morosini, Monica, Sambataro, Gianluca, Seminari, Elena, Pattonieri, Eleonora Francesca, Montecucco, Carlomaurizio, Codullo, Veronica, Bertuccio, Francesco, Marena, Carlo, Di Matteo, Angela, Cattadori, Barbara, Meloni, Federica, Ticozzelli, Elena, Bozzalla-Cassione, Emanuele, Monti, Maria Cristina

2020

Overview

The role of immunosuppression in SARS-CoV-2-related disease (COVID-19) is a matter of debate. We here describe the course and the outcome of COVID-19 in a cohort of patients undergoing treatment with calcineurin inhibitors. In this monocentric cohort study, data were collected from the COVID-19 outbreak in Italy up to 28 April 2020. Patients were followed at our hospital for solid organ transplantation or systemic rheumatic disorders (RMDs) and were on calcineurin inhibitor (CNI)-based therapy. Selected patients were referred from the North of Italy. The aim of our study was to evaluate the clinical course of COVID-19 in this setting. We evaluated 385 consecutive patients (220 males, 57%; median age 61 years, IQR 48–69); 331 (86%) received solid organ transplantation and 54 (14%) had a RMD. CNIs were the only immunosuppressant administered in 47 patients (12%). We identified 14 (4%) COVID-19 patients, all transplanted, mainly presenting with fever (86%) and diarrhea (71%). Twelve patients were hospitalized and two of them died, both with severe comorbidities. No patients developed acute respiratory distress syndrome or infectious complications. The surviving 10 patients are now fully recovered. The clinical course of COVID-19 patients on CNIs is generally mild, and the risk of superinfection seems low.

• Publisher: MDPI AG,MDPI
• Subject: Calcineurin / Calcineurin inhibitors / Communication / Coronaviruses / COVID-19 / Diarrhea / Dosage and administration / Drug dosages / Dyspnea / Enzyme inhibitors / Fever / Heart / Immunosuppression / Infections / Inhibitors / Intensive care / Lung diseases / Males / Methods / Patient outcomes / Patients / Physiological aspects / Respiratory diseases / Respiratory distress syndrome / Rheumatic diseases / Severe acute respiratory syndrome coronavirus 2 / solid organ transplantation / Statistical analysis / Superinfection / Transplantation / Transplants & implants / Viral diseases