The impact of COVID-19 pandemic on patients with ANCA associated vasculitis

Abstract

Introduction The coronavirus 2019 (COVID-19) pandemic has brought on challenges not only to acute care, but also chronic care of patients. Individuals maintained on immunosuppression appear to be especially susceptible to COVID-19 infection. Patients with ANCA-associated vasculitis (AAV) frequently require immunosuppression and may be at increased risk for developing COVID-19. The incidence and impact of COVID-19 on patients with AAV is currently not known. We aimed to investigate this impact via a telephone questionnaire-based patient survey and chart review. Methods A cross-sectional study of AAV patients followed at two centers was conducted. Data regarding demographics, disease characteristics and therapy were confirmed by chart review. A telephone survey was conducted to ascertain symptoms and contact exposure related to COVID-19, as well as changes in health care delivery during the pandemic period between January and July, 2020. Results Of the 206 patients surveyed, the median age was 64 years, 51% were female and mean (SD) disease duration was 7 (5) years. The majority had kidney (n = 160) and lung (n = 108) involvement. Seventy-five percent (n = 155) were receiving immunosuppression, with 77 patients (50%) receiving rituximab during the pandemic period. Of the 10 patients tested for severe acute respiratory syndrome coronavirus 2 (SARS CoV-2) by PCR, three were positive. Patients had a significant disruption in care; none had an in-person visit and 69% had a telemedicine consultation. Rituximab maintenance was postponed in 21 patients. Twelve patients experienced disease relapse. Conclusion The incidence of COVID-19 in patients with AAV appears to be similar to that of the general population. For a patient population that requires active clinical surveillance, there is significant disruption in care as a result of the pandemic. Reduction of immunosuppression may not be indicated, and the risk of relapse likely far outweighs the risk of COVID-19.

Timing of COVID-19 Vaccine in the Setting of Anti-CD20 Therapy: A Primer for Nephrologists

“…This includes care of patients requiring immunosuppression, with significant disruption in health care delivery to these patients reported. 1 The use of immunosuppression has been associated with high risk of severe COVID-19 disease. 2 The rapid advent of safe and efficacious COVID-19 vaccines has been hailed as a landmark achievement of modern medicine.…”

The course and outcomes of COVID-19 in patients with ANCA-associated systemic vasculitis, receiving biological therapy (Rituximab, Mepolizumab): The results of the first 8 months of the pandemic

“…Значительно большее число публикаций посвящено вопросам анти-В-клеточной терапии при COVID-19. Так, были опубликованы два отчета с анализом заболеваемости COVID-19 у пациентов с АНЦА-СВ в весенний период пандемии [41,42], которые, как и собственные данные, в это время фиксировали относительно благополучные показатели. Так, S. Banerjee и соавт.…”

“…В объединенном исследовании двух центров США и Великобритании [42] с 1 мая по 23 июля 2020 г. был проведен телефонный опрос 206 пациентов с АНЦА-СВ (средний возраст -64 года; 51% -женщины), среди которых 158 человек получали лечение ритуксимабом, в том числе 48,7% -в период пандемии, что соответствует характеристике собственной когорты (средний возраст -51 год; 61,7% -женщины; 47,6% получали лечение ритуксимабом в период пандемии). У 6% пациентов наблюдались симптомы COVID-19, у 2% присутствовал контакт с заболевшим COVID-19.…”

“…Сообщения о заболевании COVID-19 у пациентов с АНЦА-СВ, получающих лечение ритуксимабом, немногочисленны и в доступной литературе ограничены 8 случаями (табл. 4) [42,[51][52][53][54][55], суммарная летальность составила 12,5%. В собственном наблюдении получены Таблица 3.…”

Characteristics and Outcomes of COVID-19 in Patients With Antineutrophil Cytoplasmic Antibody–Associated Vasculitis

“…We recently reported significant disruption on the chronic care of patients with anti-neutrophil cytoplasmic antibody (ANCA) associated vasculitis (AAV) as result of the pandemic, with a sizeable proportion of patients having their immunosuppression held and that the risk of disease relapse likely far outweighs the risk of COVID-19. 1 Also, with the use of protective equipment and adherence to social isolation restrictions, the incidence of COVID-19 in patients with AAV may be similar to that of the general population. The characteristics and outcomes of COVID-19 in patients with new and established diagnosis of ANCA remains largely unknown, with only few cases reported.…”