Risks and treatment related aspects of COVID-19 infection in patients with ANCA-associated vasculitis

• Published in: Scandinavian journal of rheumatology 2023, Vol.52 (4), p.418-423
• Main Authors: Antovic, A, Bruchfeld, A, Ekland, J, Lövström, B, Hugelius, A, Börjesson, O, Knight, A, Gunnarsson, I
• Format: Article
• Language: English
• Subjects: Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis - diagnosis; Antibodies, Antineutrophil Cytoplasmic; COVID-19; Humans; Immunosuppressive Agents - therapeutic use; Medicin och hälsovetenskap; Rituximab - therapeutic use
• ISSN: 0300-9742; 1502-7732; 1502-7732
• DOI: 10.1080/03009742.2022.2109337

Patients with anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) require immunosuppressive therapy for disease control and relapse prevention and may be at risk for severe coronavirus disease 2019 (COVID-19). The study objective was to analyse risk factors and outcomes of COVID-19 in well-characterized AAV patients. Data were retrieved from March 2020 to May 2021 from medical records of AAV cohorts in Stockholm and Uppsala, Sweden. COVID-19 was confirmed by positive PCR test or by ELISA. Severe COVID-19 was defined as need for non-invasive ventilation, intensive care unit care, and/or death. Age, gender, ANCA antibody type, ongoing immunosuppressive medication, and estimated glomerular filtration rate were recorded. The cohort comprised 310 AAV patients, of whom 29 (9%) were diagnosed with COVID-19. Four deaths were attributed to COVID-19. Fifteen patients (52%) were on prednisolone in the COVID-19 group and 130 (46%) in the non-COVID group, with significantly higher doses in COVID-19 patients (p < 0.01). Ongoing induction therapy was more prevalent in the COVID-19 group (p < 0.01). Severe COVID-19 was diagnosed in 9/29 (31%). Significant risk factors for severe COVID-19 were impaired kidney function (p = 0.01) and more intense immunosuppressive therapy (p = 0.02), with a trend for age (p = 0.07). Maintenance therapy with rituximab was not associated with severe COVID-19. Our findings highlight risks and suggest that more attention should be given to optimal AAV treatment in a pandemic situation. They also emphasize the need for continued shielding, mitigation strategies, and effective vaccination of AAV patients.