AAV Patients Not at Greater COVID-19 Risk, But Care Is Disrupted Due to Pandemic

People with ANCA-associated vasculitis (AAV) have a similar incidence of COVID-19 as the general population, but the ongoing pandemic has significantly disrupted routine medical care for patients with this autoimmune disease, a study found.

Some AAV patients had therapies postponed or had healthcare visits rescheduled; 16% had less frequent blood draws. None of the participants had in-person visits with doctors or other care providers during the study’s nearly two-month duration.

Moreover, despite earlier reports suggesting that immunosuppressive medications increase the risk and severity of COVID-19, the findings support the continued use of these medications in AAV patients, whose “risk of relapse likely far outweighs the risk of COVID-19,” according to the researchers.

The study, “The impact of COVID-19 pandemic on patients with ANCA associated vasculitis,” was published in the Journal of Nephrology.

The COVID-19 pandemic has brought on challenges to the care of patients with chronic diseases, including those with AAV.

The AAV population often uses immunosuppressive medications to dampen their excessive immune responses and prevent relapses, but these medications initially were suspected of putting patients at a greater risk of COVID-19 or increasing their risk of a more severe infection.

Despite those concerns, there have been no studies examining the incidence or severity of COVID-19 in AAV patients. Such studies would support guidelines on the use of immunosuppressive medications in these patients during the pandemic, scientists noted.

To address the incidence and impact of COVID-19 on people with AAV, researchers at the Johns Hopkins University School of Medicine and their colleagues now examined data from 206 people with AAV in the U.S. and the U.K. The patients were being followed at the Johns Hopkins Vasculitis Center, in Baltimore, and at the Royal Preston Hospital, in Lancashire, in the U.K.

In addition to collecting patients’ clinical characteristics from medical records, the researchers surveyed the individuals by telephone, between May 1 and July 23. Their goal was to learn of symptoms and contact exposures related to COVID-19, and to collect data about changes in health care delivery during the pandemic.

The participants were a near equal mix of men and women, with median age of 64 years, who had the disease for an average of seven years. A majority of them (75%) were receiving immunosuppressant medication for AAV, including 50% who were on rituximab.

Concerning personal protective measures against COVID-19, 97% of the surveyed AAV patients reported using a mask or face shield, while 98% followed social distancing guidelines, and 92% frequently washed their hands. A total of 83% reported taking all three measures.

While most participants (about 94%) reported no symptoms of infection, seven reported having a cough, six experienced breathing difficulties, and four had fever and muscle soreness. Seven of the symptomatic patients were not tested for COVID-19 infection and said they no longer had symptoms at the survey time. Four asymptomatic and six symptomatic participants were tested for COVID-19; three of them were positive.

When asked about care delivery, 69% of patients reported having video visits with their health care provider. None had in-person visits and 13% had rescheduled visits. Also, 10% of patients saw their rituximab therapy postponed.

During the pandemic, 12 patients experienced relapse after an average disease duration of five years. All of these patients were on immunosuppressive therapy; among the five patients on rituxumab, one missed one infusion and another had an infusion postponed due to the pandemic. None of the relapsing patients had a COVID-19 infection.

Of the three patients who tested positive for COVID-19, two were admitted into the intensive care unit, receiving oxygen, and non-invasive ventilation. The patients all continued their remission induction and maintenance therapies throughout their COVID-19 illness, and all recovered within three to 64 days.

“Our data demonstrate that continual monitoring of AAV patients during the pandemic is paramount,” the investigators wrote.

“Patients with AAV have a similar incidence of COVID-19 in comparison to the general population,” they noted.

Despite early concerns, there was no evidence of an increased incidence of COVID-19 among this patient population. In addition, there was no evidence to suggest that AAV treatments increased the risk or severity of COVID-19.

“Withdrawal of maintenance therapy to prevent COVID-19 may not be advisable in most circumstances and may be associated with disease relapse,” the researchers concluded.