New insights of antineutrophil cytoplasmic antibody-associated vasculitis from the perspective of COVID-19 vaccination

Abstract

Summary The occurrence of antineutrophil cytoplasmic antibodies (ANCA)-associated vasculitis (AAV) has been reported since the Coronavirus disease 2019 (COVID-19) vaccination, but whether there is a causal relationship or coincidence remains to be verified. We combined the term COVID-19 vaccination with each word of AAV to search for case reports and case series published in PubMed, EMBASE, and Web of Science databases before 13 th March 2023. A total of 56 patients who developed AAV after COVID-19 vaccination were identified from 44 research centers. Of the 56 subjects, 43 (76.7%) were vaccinated with the mRNA vaccine, followed by the adenovirus vaccine (14.3%) and inactivated vaccine (9.0%) (P = 0.015). Compared with relapsed AAV, new-onset AAV patients had at least two other diseases previously (P < 0.001). 25 (44.6%) patients presented symptoms after the first injection, and the medium onset time was 12 (1-77) days, while 28 (50.0%) patients developed symptoms after the second dose, and their medium period was 14 (1-60) days. 44 (78.5%) patients achieved remission after immunosuppressive agents, plasma exchange, and hemodialysis. One (1.8%) patient died from progressive respiratory failure and 9 (16.1%) did not recover, leaving 5 patients permanently dependent on hemodialysis. Pathogenic ANCA may be activated by enhanced immune response and epitope spreading after COVID-19 vaccination and induced the occurrence of AAV, especially in genetically susceptible populations.

BA.1/BA.5 Immunogenicity, Reactogenicity, and Disease Activity after COVID-19 Vaccination in Patients with ANCA-Associated Vasculitis: A Prospective Observational Cohort Study

“…AAV patients are particularly susceptible to COVID-19 breakthrough infections and severe disease courses, possibly due to their advanced age at initial diagnosis combined with an extensive immunosuppressive therapy [ 23 ]. In addition, safety concerns have been raised regarding the use of highly immunogenic mRNA vaccines in autoimmune diseases such as AAV vasculitis, and relapses have been reported in several case series [ 20 , 24 , 25 , 26 , 27 ]. However, because AAV vasculitis is an orphan disease and patients have been excluded from most vaccine trials, data on SARS-CoV-2 vaccination are still limited and prospective vaccination studies that have focused exclusively on AAV patients are lacking.…”