Abstract
Objective: To determine the effect of methotrexate (MTX) on clinical course of COVID-19 in autoimmune rheumatic disorders (AIRD).
Methodology: This observational cohort study was carried out at Fauji Foundation Hospital, Rawalpindi, Pakistan. We recruited 100 patients with AIRD having COVID-19. Data related to demographics, AIRD (diagnosis, treatment, activity) and COVID-19 {symptoms, duration, complications, and outcome (Mortality, invasive ventilation, hospitalization, and ICU admission} were recorded. Patients were divided into 2 groups: group 1 using MTX and group 2 not using MTX. These were compared using chi-square, student’s t-test and logistic regression.
Results: MTX was used by 48% of patients. Group 1 patients were older than group 2 (49.3±13.65 vs 41.69±12.84; t -3.07, p=0.003). Dyspnea (56% vs 36%) and altered taste (27% vs 10%) were significantly higher in group1 (LR 3.9, 5.16 and p=0.048 and 0.02, respectively). Mortality (LR 1.33, p=0.25), hospitalization (LR 0.24, p=0.63), ICU admission (LR 2.06, p=0.15) and ventilation (LR 0.8, p=0.78) were same in both groups. Steroid users in group 1 had higher mortality (20% vs none, LR 6.15, p=0.013) than group 2 (32% vs 11%, LR 3.38, p=0.06). Higher AIRD activity was associated with higher mortality (LR 13.53, p=0.004) and ventilation requirements (LR 9.96, p=0.019) only in group 2.
Conclusion: Methotrexate may favourably alter the course of COVID-19 in patients with AIRD. But its effect may be modified by other factors like steroid use and AIRD activity.

Key words: DMARD, hospitalization, methotrexate, rheumatoid arthritis, systemic lupus erythematosus.