Calcineurin Inhibitor-Based Immunosuppression and COVID-19: Results from a Multidisciplinary Cohort of Patients in Northern Italy
covid-19, solid organ transplantation, Rheumatic diseases, calcineurin inhibitors
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 April 28th 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.
Lorenzo Cavagna, Elena Seminari, Giovanni Zanframundo, Marilena Gregorini, Angela Di Matteo, Teresa Rampino, Carlomaurizio Montecucco, Stefano Pelenghi, Barbara Cattadori, Eleonora Francesca Pattonieri, Patrizio Vitulo, Alessandro Bertani, Gianluca Sambataro, Carlo Vancheri, Alessandro Biglia, Emanuele Bozzalla-Cassione, Valentina Bonetto, Maria Cristina Monti, Elena Ticozzelli, Annalisa Turco, Tiberio Oggionni, Angelo Corsico, Francesco Bertuccio, Valentina Zuccaro, Veronica Codullo, Monica Morosini, Carlo Marena, Massimiliano Gnecchi, Carlo Pellegrini, Federica Meloni