Comparison of risk factors during first and second wave of COVID-19 in patients with autoimmune rheumatic diseases (AIRD)-results from KRACC subset

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.