Overall, 2.8 percent of a national cohort of commercially insured U.S. adults meet criteria for drug-induced immunosuppression, of whom 67.7 percent receive oral corticosteroids, according to a research letter published online May 20 in JAMA Network Open.
Beth I. Wallace, M.D., from the University of Michigan Medical School in Ann Arbor, and colleagues conducted a cross-sectional study using direct pharmaceutical claims to describe the prevalence of drug-induced immunosuppression among 3,169,441 continuously enrolled patients.
The researchers found that 2.8 percent of the participants met the criteria for drug-induced immunosuppression during the period from Jan. 1, 2018, through Dec. 31, 2019. Most of those receiving immunosuppressive drugs were older (median age, 53 years) and were women (61.2 percent). Prednisone, methotrexate, and methylprednisolone were the most commonly prescribed drugs (53.0, 24.5, and 21.6 percent, respectively), and together, these drugs were used by 62.5 percent of patients. Overall, 67.7 percent of patients received oral corticosteroids, and 40.9 percent received oral corticosteroids for 30 days or longer within a period of 365 days. Malignant neoplasms, immune-mediated conditions, and inflammatory skin conditions were the most common immunosuppression-associated diagnosis categories (73.8, 68.8, and 38.8 percent, respectively).
“We’re starting to realize that people taking immunosuppressive drugs may have a slower, weaker response to COVID vaccination, and, in some cases, might not respond at all,” Wallace said in a statement. “We don’t have a full picture on how these drugs affect the vaccine’s effectiveness, so it’s difficult to formulate guidelines around vaccinating these patients.”
Several authors disclosed ties to the biopharmaceutical and medical device industries, and two authors were included on patents.