ANCA Vasculitis Induction Management During the COVID-19 Pandemic

Salas, Antonio; Kant, Sam; Floyd, Lauren; Krátký, Vojtěch; Brix, Silke R.; Prendecki, Maria; Schönermarck, Ulf; Scott, Jennifer; Saha, Manish; Gauckler, Philipp; Li, Tingting; Sharma, Purva; Ayoub, Isabelle; Morris, Adam; Dhaygude, Ajay; Hrušková, Zdenka; Tesař, Vladimı́r; McAdoo, Stephen P; Little, Mark A.; Derebail, Vimal K.; Poulton, Caroline J.; Seo, Philip; Kronbichler, Andreas; Geetha, Duvuru

doi:10.1016/j.ekir.2021.08.009

Cited by 8 publications

(9 citation statements)

References 9 publications

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“…Only 17.6% ( n = 18) of the respondents of our study reported changes in their therapeutic regimens (i.e., shifts, reductions, or discontinuations) due to COVID-19. Our results are consistent with previous reports that documented no major changes in the management of vasculitis patients during the COVID-19 pandemic ( 20 , 29 ). This might be explained by the profound importance of current drug regimens used to prevent flare-ups in order to prevent irreversible damage or death in patients with uncontrolled vasculitis ( 30 , 31 ).…”

Section: Discussionsupporting

confidence: 93%

“…To the best of our knowledge, this is the first patient survey designed to assess (1) the changes in medical care provided to vasculitis patients in the COVID-19 pandemic and (2) vaccination acceptance in this patient cohort. While several published reports document the results of surveys that included patients with RMDs, the proportion of vasculitis patients was small and their responses were not analyzed separately; in other studies, only data from the first month of the pandemic were presented (18)(19)(20)(21)(22).…”

Section: Discussionmentioning

confidence: 99%

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COVID-19 pandemic impairs medical care of vasculitis patients in Germany: Results of a national patient survey

et al. 2023

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ObjectiveTo analyze the impact of the COVID-19 pandemic on medical care and vaccination acceptance of vasculitis patients in Germany.MethodsA web-based national survey was developed by rheumatology centers and vasculitis patient advocacy groups. The survey was distributed nationwide by mail and flyers and could be accessed via a QR-code or weblink from December 2021 to April 2022. Descriptive statistics [mean, median, standard derivation (SD), 25%, 75% quantile] were calculated. 95% confidence intervals were presented for responses that were directly related to the impact of COVID-19 on parameters associated with vasculitis patient care.ResultsThe online survey was completed by 117 patients with small and large vessel vasculitis [granulomatosis with polyangiitis (n = 69), eosinophilic granulomatosis with polyangiitis (n = 16), microscopic polyangiitis (n = 12), giant cell arteritis (n = 17) and Takayasu's arteritis (n = 3)]. Prescheduled rheumatological appointments had been canceled due to the COVID-19 pandemic in 12.6% of the respondents [95% confidence interval (CI), 7.3–20.0%); in 9% (95% CI, 4.5–15.6%)] appointments had been replaced by digital services. Therapeutic regimens were changed (shifted, reduced, or discontinued) due to the pandemic in 15.5% (95% CI 9.5–22.2%). Vaccination coverages were generally high compared to patients with other rheumatic diseases and the general population. Highest vaccination coverage was observed against COVID-19 (98.1% 95% CI 93.9–99.6%).ConclusionVasculitis patients experienced changes in medical care during COVID-19 pandemic such as cancelation of prescheduled rheumatology appointments and modifications in therapeutic regimens. The overall acceptance rate for vaccination was comparatively high, particularly for vaccination against COVID-19.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

COVID-19 pandemic impairs medical care of vasculitis patients in Germany: Results of a national patient survey

et al. 2023

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“…Although immunosuppressive therapy increases the risk of COVID-19 infection, there is currently no evidence to support deviation in the standard of care treatment of active kidney disease 36 . COVID-19 in patients with immune-mediated kidney disease conferred an increased risk of AKI and death 37 .…”

Section: Challenges and Opportunities Of Covid-19mentioning

confidence: 99%

Impact of the COVID-19 pandemic on the kidney community: lessons learned and future directions

et al. 2022

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The coronavirus disease 2019 (COVID-19) pandemic has disproportionately affected patients with kidney disease, causing significant challenges in disease management, kidney research and trainee education. For patients, increased infection risk and disease severity, often complicated by acute kidney injury, have contributed to high mortality. Clinicians were faced with high clinical demands, resource shortages and novel ethical dilemmas in providing patient care. In this review, we address the impact of COVID-19 on the entire spectrum of kidney care, including acute kidney injury, chronic kidney disease, dialysis and transplantation, trainee education, disparities in health care, changes in health care policies, moral distress and the patient perspective. Based on current evidence, we provide a framework for the management and support of patients with kidney disease, infection mitigation strategies, resource allocation and support systems for the nephrology workforce.

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“…However, a number of studies have reported favourable outcomes in patients with AAV with glomerular involvement who were B cell deplete at the time of infection [20,21] Additionally, there are an accumulating number of case reports describing relatively mild COVID-19 and positive outcomes in patients receiving induction/augmented immunosuppression for severe glomerular disease with high-dose steroids, rituximab and cyclophosphamide at the time of SARS-CoV-2 infection [22][23][24][25][26][27][28][29][30]. Moreover, in a large international retrospective cohort study including 155 AAV patients with glomerular disease receiving induction immunosuppression, there was no difference in COVID-19 outcomes between patients treated with rituximab, cyclophosphamide or combined therapy with rituximab and cyclophosphamide, although the SARS-CoV-2 infection rate was low [31]. In another large case series including 160 AAV patients with glomerular disease, the incidence of COVID-19 was again low (1.4%), but 30% of patients receiving rituximab maintenance therapy had their infusions postponed, of whom 20% experienced disease relapse [32].…”

Section: Key Pointsmentioning

confidence: 99%

COVID-19 in patients with glomerular disease

Turner‐Stokes

Edwards

Lightstone

2021

Current Opinion in Nephrology &Amp; Hypertension

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Purpose of reviewManaging patients with glomerular disease during the COVID-19 pandemic has been challenging, as the infection risk associated with immunosuppression must be balanced against the need to control severe glomerular disease that can lead to kidney failure. This review provides an overview of COVID-19 and the effectiveness of SARS-CoV-2 vaccination in patients with glomerular disease. Recent findingsRegistry data, although biased towards outcomes of hospitalized patients, suggest that the mortality from COVID-19 is higher in patients with glomerular disease than in the general population. Glucocorticoid use prior to SARS-CoV-2 infection is associated with adverse outcomes from COVID-19. Rituximab significantly attenuates serological responses to both natural infection and vaccination against SARS-CoV-2, although it is not clear whether this leads to adverse outcomes. Case reports of disease flares occurring after vaccination have been reported, but causality in any of these cases has yet to be proven and the absolute risk remains very small. SummaryPatients with glomerular disease represent an at-risk group for severe COVID-19 disease and vaccination is key to reducing this risk. As immunosuppressed patients demonstrate an attenuated response to vaccination, the efficacy of a third primary dose followed by a subsequent booster is being investigated.

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ANCA Vasculitis Induction Management During the COVID-19 Pandemic

Cited by 8 publications

References 9 publications

COVID-19 pandemic impairs medical care of vasculitis patients in Germany: Results of a national patient survey

COVID-19 pandemic impairs medical care of vasculitis patients in Germany: Results of a national patient survey

Impact of the COVID-19 pandemic on the kidney community: lessons learned and future directions

COVID-19 in patients with glomerular disease

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