Abstract: A Prospective Longitudinal Study Evaluating The Influence of Immunosuppressives and Other Factors On COVID-19 in Autoimmune Rheumatic Diseases Abhishek Patil Manipal Hospital Chanakya K St. John’s Medical College Hospital Padmanabha Shenoy CARE Hospitals Chandrashekara S ChanRe Rheumatology and Immunology Centre Vikram Haridas Arthritis Superspeciality centre Sharath Kumar OARC Manisha Daware Narayana Health Ramya Janardana St. John’s Medical College Hospital Benzeeta Pinto St. John’s Medical College Hospital Ramaswamy Subramaniam JSS Medical College and Hospital Nagaraj S Columbia Asia Yogesh Preet Singh Manipal Hospital Shweta Singhai Sakra Hospital Ramesh Jois Vikram Hospital Vikramraj Jain Bhagwan Mahaveer Jain Hospital Page 1/20 Srinivasa C Fortis Hospital BG Dharmanand Vikram Hospital Chethana Dharmapalaiah Aster CMI Sangeetha KN Anagha Hospital Vijay K Rao Manipal Hospital Vineeta Shobha (  vineeta.s@stjohns.in ) St. John’s Medical College Hospital Research Article Keywords: Autoimmune rheumatic diseases, SARS-CoV-2 infection, risk factors, outcome, hydroxychloroquine, glucocorticoid, immunosuppressants. DOI: https://doi.org/10.21203/rs.3.rs-805748/v1 License:   This work is licensed under a Creative Commons Attribution 4.0 International License. Read Full License Page 2/20 Abstract Background We conducted this study to identify the influence of prolonged use of hydroxychloroquine(HCQ), glucocorticoids (GC) and other immunosuppressants (IS) on occurrence and outcome of COVID-19 in patients with autoimmune rheumatic diseases (AIRDs). Methods This was a prospective, multicenter, non-interventional longitudinal study across 15 specialist rheumatology centers. Consecutive AIRD patients on treatment with immunosuppressants were recruited and followed up longitudinally to assess parameters contributing to development of COVID-19 and its outcome. Results COVID-19 occurred in 314(3.45%) of 9212 AIRD patients during a median follow up of 177 (IQR 129,219) days. Long term HCQ use had no major impact on the occurrence or the outcome of COVID-19. Glucocorticoids in moderate dose (7.5-20mg/day) conferred higher risk (RR = 1.72) of infection. Among the IS, Mycophenolate mofetil (MMF), Cyclophosphamide (CYC) and Rituximab (RTX) use was higher in patients with COVID 19. However, the conventional risk factors such as male sex (RR = 1.51), coexistent diabetes mellitus (RR = 1.64), pre-existing lung disease (RR = 2.01) and smoking (RR = 3.32) were the major contributing risk factors for COVID-19. Thirteen patients (4.14%) died, the strongest risk factor being pre-existing lung disease (RR = 6.36, p = 0.01). Incidence ((17.5 vs 5.3 per 1 lakh (Karnataka) and 25.3 vs 7.9 per 1 lakh(Kerala) ) and case fatality (4.1% vs 1.3 % (Karnataka) and 4.3% vs 0.4% (Kerala)) rate of COVID-19 was significantly higher (p < 0.001) compared to the general population of the corresponding geographic region. Conclusions Immunosuppressants have a differential impact on the risk of COVID-19 occurrence in AIRD patients. Older age, males, smokers, hypertensive, diabetic and underlying lung disease contributed to higher risk. The incidence rate and the case fatality rate in AIRD patients is much higher than that in the general population. Key Message 1. Long term HCQ use had no major impact on the occurrence or the outcome of COVID-19 in AIRD. Page 3/20 2. Glucocorticoids in moderate doses increased the risk of COVID-19 in AIRD patients. 3. The incidence rate of..