Study Highlights Decreased Mortality Among SAH Patients Treated with Corticosteroids Post-COVID

Samer Gawrieh, MD

Credit: IU Health

Patients with severe alcohol-associated hepatitis treated with corticosteroids experienced decreased mortality rates after the COVID-19 pandemic, suggesting infection mitigation measures may have collaterally benefited these individuals.

Presented at The Liver Meeting 2023 from the American Association for the Study of Liver Diseases (AASLD) in Boston this weekend by Samer Gawrieh, MD, professor of clinical medicine at Indiana University School of Medicine, the study compared data from 5 clinical trials before and during the COVID-19 outbreak.¹

“Corticosteroids are the standard of care for severe alcohol-associated hepatitis in the absence of contraindications. Survival benefits conferred by steroids are often gained at the expense of increased infection risk,” wrote investigators.¹

Corticosteroids are an anti-inflammatory medication prescribed for a wide range of conditions. In addition to reducing inflammation, they also reduce the production of antibodies and subsequently suppress the immune system. Lower resistance to infection is a notable side effect of corticosteroids, raising questions regarding the impact of the COVID-19 pandemic on these patients who are more susceptible to infection.²

To assess the coincidental impact of infection mitigation measures during the COVID-19 pandemic on mortality in patients with severe alcohol-associated hepatitis treated with corticosteroids, investigators collected data from 3 clinical studies conducted before the COVID-19 outbreak, 1 during the pandemic, and 1 with a timeframe before and during COVID-19.¹

Investigators defined April 1, 2020, as the start of COVID-19 outbreak period because the ongoing studies stopped recruitment in the early months of the pandemic. Mortality rates at 28, 90, and 180 days were compared between the pre and during-COVID pandemic periods in patients treated with corticosteroids. Cox regression analyses were performed to compare survival rates while controlling for patient characteristics.¹

In total, data from 575 patients were examined, including 415 from pre-COVID-19 and 160 during COVID-19. Investigators pointed out patients recruited during the COVID-19 pandemic were younger (43.7 years of age vs 46.5 years of age in the pre-COVID period) but mean MELD scores were similar (25.7 for pre-and 24.8 for during-COVID periods).¹

Investigators noted mortality rates at 28 (11.6% vs 2.5%), 90 (22.4% vs 10%), and 180 (26.5% vs 15%) days were consistently greater in the pre-pandemic period compared to during the pandemic. After controlling for MELD and patient characteristics, the adjusted hazard ratios of the during-COVID period for 28, 90, and 180 days survival were 0.28 (95% confidence interval, 0.1-0.79), 0.51 (95% CI, 0.3-0.87), and 0.57 (95% CI, 0.36-0.89), respectively (all P < .05).¹

“The markedly lower mortality rates in SAH patients treated with steroids after the COVID outbreak raise the possibility that infection mitigation measures enacted during the pandemic may have collaterally benefited patients on corticosteroid therapy,” concluded investigators.¹

References:

1. Tu W, Nephew LD, Dasarathy S, et al. 169: DECREASED MORTALITY IN PATIENTS WITH SEVERE ALCOHOL-ASSOCIATED HEPATITIS (SAH) TREATED WITH CORTICOSTEROIDS DURING THE COVID PANDEMIC. Paper presented at: The Liver Meeting. Boston, MA. November 10 - 14, 2023
2. Cleveland Clinic. Corticosteroids. Drugs, Devices, & Supplements. January 20, 2020. Accessed November 13, 2023. https://my.clevelandclinic.org/health/drugs/4812-corticosteroids