Abstract: PO1629
ANCA Vasculitis Induction Management in the COVID-19 Pandemic: Results of an International Retrospective Cohort Study
Session Information
- Glomerular Diseases: Treatment and Outcomes
November 04, 2021 | Location: On-Demand, Virtual Only
Abstract Time: 10:00 AM - 12:00 PM
Category: Glomerular Diseases
- 1203 Glomerular Diseases: Clinical, Outcomes, and Trials
Authors
- Salas, Antonio, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
- Geetha, Duvuru, Johns Hopkins University Department of Medicine, Baltimore, Maryland, United States
Group or Team Name
- ANCAITCOV
Background
Induction therapy for severe ANCA-associated vasculitis (AAV) combines glucocorticoids (GC) with either rituximab (RTX) or cyclophosphamide (CYC). The coronavirus 2019 disease (COVID-19) pandemic has increased concern around using aggressive immunosuppression; whether this concern has impacted AAV management is unknown. Here, we report treatment regimens and outcomes of patients with active AAV receiving induction immunosuppression during the first wave of the pandemic.
Methods
We retrospectively studied AAV patients with new or relapsing disease receiving remission induction therapy during the first wave of the COVID-19 pandemic across sites in the US, UK and Europe. Primary outcome was achievement of complete remission at 6 months.
Results
Of 191 patients with a mean age of 65 years old, 52% were female and a majority (89%) were Caucasian. Standard induction was deployed across all sites. Out of the US, UK, and European patient populations, the US used higher GC pulses leading to a higher average cumulative GC dose for remission induction (4153 mg, 2174 mg, 3408 mg, respectively, p<0.001) and had the highest proportion of patients given RTX induction therapy (64%; p=0.005). Complete remission was achieved in 90% of patients. Improvement in kidney function at 6 months was similar with all treatment regimens (6 ml/min2 increase, p=0.68). Sixteen patients were diagnosed with COVID-19 and had similar exposures to CYC and RTX. There were no differences in remission rates, ESKD or death when stratified by induction therapy type.
Conclusion
Induction immunotherapy practices differ across the world, but specialists continued their standard management during the COVID-19 pandemic. AAV outcomes or rates of COVID-19 infection were not influenced by different induction regimens.
Treatment differences and 6M remission among different cohorts
| Treatment variables | Entire cohort | United States | United Kingdom | Europe | P-value |
| Use of pulse GCs, n (%) | 117 (61); n=191 | 35 (80); n=44 | 44 (53); n=83 | 38 (59); n=64 | 0.013 |
| Mean (SD) cumulative dose of IV pulse methylprednisolone in mg | 930 (981); n=175 | 1658 (1243); n=43 | 730 (755); n=74 | 647 (733); n=58 | <0.001 |
| Mean (SD) cumulative GC for remission induction in mg | 2962 (1841); n=171 | 4153 (2427); n=35 | 2174 (1229); n=83 | 3408 (1642); n=53 | <0.001 |
| RTX use only, n (%) | 84 (44); n=191 | 28 (64); n=44 | 28 (34); n=83 | 28 (44); n=64 | 0.005 |
| CYC use only, n (%) | 49 (26); n=191 | 5 (11); n=44 | 23 (28); n=83 | 21 (33); n=64 | 0.037 |
| RTX and CYC, n (%) | 49 (26); n=191 | 10 (23); n=44 | 28 (34); n=83 | 11 (17); n=64 | 0.066 |
| Remission at 6 months, n (%) | 160 (90); n=178 | 37 (90); n=41 | 64 (85); n=75 | 59 (95); n=62 | 0.164 |