ABSTRACT
Background: The differential influence and outcome of various risk factors on occurrence of COVID-19 among patients with autoimmune rheumatic diseases (AIRD) during different COVID-19 peaks is underreported. Aim(s): To assess the impact and outcome of conventional risk factors, immunosuppressants and comorbidities on the risk of COVID-19 among AIRD patients during the first two COVID-19 peaks. Design(s): Prospective, non-interventional longitudinal cohort study. Method(s): This is a subset of the KRA COVID19 cohort undertaken during the initial wave of COVID-19 (W1) (Apr-Dec 2021);and the 2nd-wave (W2) (Jan-Aug 2021). Data collected included description of AIRD subsets, treatment characteristics, comorbidities and COVID-19 occurrence. Risk factors associated with mortality were analyzed. The incidence rate was compared with that of the general population in the same geographic region. Result(s): AIRD patients (n = 2969) had a higher incidence of COVID-19 in the W2 (7.1%) than in the W1 (1.7%) as compared to the general population (Government bulletin). Age (P < 0.01) and duration of AIRD (P < 0.001) influenced COVID-19 occurrence in W2 while major disease subsets and immunosuppressants including glucocorticoids did not. The W2 had lower HCQ usage (aRR-0.81) and comorbidities like hypertension (aRR-0.54) and pre-existing lung disease (aRR-0.38;0.19-0.75) compared to W1. Older age (aRR-1.11) and coexistent diabetes mellitus (aRR 6.74) were independent risk factors associated with mortality in W2. Conclusion(s): We report 1.7 times higher occurrence and no influence of major disease subsets or immunosuppressants including glucocorticoids on COVID 19. Age and diabetes were independent risk factors for mortality.