The coronavirus disease 2019 (COVID-19) pandemic has created challenges for the care of chronic conditions, such as rheumatic diseases, including disruption of clinic visits and treatment. In particular, there is evidence that immunosuppressed individuals—like many patients with autoimmune diseases—may be at higher risk of infection with SARS-CoV-2, the virus that causes COVID-19. Researchers at the Johns Hopkins Vasculitis Center found that patients with ANCA vasculitis, a rare autoimmune disease that causes blood vessel inflammation, have experienced significant disruptions in care during the pandemic. Despite treatment with immunosuppression, however, the incidence of COVID-19 in ANCA vasculitis patients is similar to that of the general population. The authors of the study do not recommend withdrawal of maintenance immunosuppressive therapy, as the risk of vasculitis relapse outweighed the risk of COVID-19 in this patient group.
Why was this study done?
This study sought to assess the incidence of COVID-19 and the impact of the pandemic on clinical care and disease course in patients with ANCA vasculitis.
How was this study done?
Researchers collected information on disease characteristics, therapy use, and COVID-19 infections by reviewing medical records and conducting telephone surveys of ANCA vasculitis patients followed at the Johns Hopkins Vasculitis Center and the Royal Preston Hospital, Lancashire, U.K.
What were the major findings?
Of the 206 patients followed, the majority had kidney and lung disease associated with their vasculitis. Most patients reported a disruption of care during the pandemic, including conversion of in-person to telemedicine appointments, rescheduling clinic visits and follow-up labs, and postponing treatment. About 75% of patients were on some form of immunosuppressive therapy—50% of whom received rituximab during the pandemic. One-third of patients on rituximab had their infusions postponed, and a total of 12 patients, including 2 that postponed rituximab, experienced a relapse in their vasculitis. Nearly all patients reported following personal protective measures to prevent COVID-19; of 10 patients tested for SARS-CoV-2 infection, only 3 tested positive and required hospitalization—all of whom recovered. Relapse of vasculitis during the pandemic, therefore, exceeded the incidence of COVID-19, which was similar to that of the general population.
What is the impact of this work?
This is the first study to demonstrate that the incidence of SARS-CoV-2 infection in patients with ANCA vasculitis is similar to that of general population, despite immunosuppression. The authors recommend that ANCA vasculitis patients should follow CDC guidelines for the prevention of COVID-19 and continue regular visits with their physician, in addition to laboratory testing, to monitor risk of vasculitis relapse. They further conclude that maintenance immunosuppressive medications should not be stopped, as risk of relapse outweighed COVID-19 risk in this patient population.
The impact of COVID-19 pandemic on patients with ANCA associated vasculitis. Kant S, Morris A, Ravi S, Floyd L, Gapud E, Antichos B, Dhaygude A, Seo P, Geetha D. J Nephrol. 2020 Oct 8:1-6. doi: 10.1007/s40620-020-00881-3. Online ahead of print.