Risks and treatment related aspects of COVID-19 infection in patients with ANCA-associated vasculitis

Figures & data

Table 1. Characteristics of the patients diagnosed with COVID-19 and non-COVID-19 patients.

Subjects’ characteristics	All patients	Non-COVID-19 group	COVID-19 group	p
Number of patients	310	281 (91)	29 (9)
Age (years), median (IQR)	67 (53.5–76.0)	68 (55.0–77.0)	60 (40.5–72.5)	0.02
Gender, female/male	157/153 (50.5–49.5)	143/138 (51/49)	14/15 (50/50)	ns
Diagnosis				ns
GPA	232	210	22
MPA	56	51	5
EGPA	22	20	2
ANCA
None	16	12	4	ns
PR3	206	186	20
MPO	83	78	5
Both	5	5	0
Lung involvement*	170 (55)	151 (54)	19 (66)	ns
Renal involvement†	169 (55)	152 (54)	17 (59)	ns
eGFR (mL/min/1.73 m^2), median (IQR)	64 (47.5–781.5)	64 (47.5–78.0)	73.0 (49.0–87.5)	ns
Treatment
Number on prednisolone	145 (47)	130/281 (46)	15/29 (52)	ns
Prednisolone dose (mg/day) (median, min–max)	5 (0.625–50)	5 (0.625–20)	6.25 (2.5–50)	< 0.01
DMARD‡	201 (65)	182 (65)	19 (65.5)	ns
Induction therapy (RTX and/or CYC)	11 (3.5)	7 (2.5)	4 (14)	< 0.01
RTX induction	4	3	1
RTX and CYC induction	1	0	1
CYC induction	6 (2)	4 (2)	2 (7)	ns
RTX maintenance	87 (28)	79 (28)	8 (28)	ns

Data are shown as n or n (%), unless otherwise indicated.

*Pulmonary involvement (ever) defined as the presence of clinical/radiological findings (evidenced by high-resolution computed tomography chest scans) consistent with AAV.

†Kidney involvement (ever) defined as kidney biopsy findings consistent with pauci-immune vasculitis or clinical presentation with affected kidney function and/or significant haematuria (≥ 2 on dipstick urinalysis or > 10 erythrocytes per high-power field on urinary sediment).

‡Methotrexate, azathioprine, mycophenolate mofetil.

COVID-19, coronavirus disease 2019; IQR, interquartile range; GPA, granulomatosis with polyangiitis; MPA, microscopic polyangiitis; EGPA, eosinophilic granulomatosis with polyangiitis; PR3, proteinase-3; MPO, myeloperoxidase; eGFR, estimated glomerular filtration rate; DMARD, disease-modifying anti-rheumatic drug; RTX, rituximab; CYC, cyclophosphamide; ns, not significant.

Table 2. Characteristics comparing non-severe and severe COVID-19 infection.

Subjects’ characteristics	Non-severe COVID-19	Severe COVID-19	p
Number of patients	20 (69)	9 (31)
Age (years), median (IQR)	51 (35.5–64.5)	69 (55.5–75.0)	0.07
Gender, female/male	10/10 (50/50)	4/5 (45/55)	ns
Diagnosis			ns
GPA	16	6
MPA	3	2
EGPA	1	1
ANCA			ns
None	2	2
PR3	15	5
MPO	3	2
Both	0	0
Lung involvement	13 (65)	6/9 (67)	ns
Renal involvement	11(55)	6/9 (67)	ns
eGFR (mL/min/1.73 m^2), median (IQR)	80.5 (61.5–89.0)	53.0 (28.5–67.5)	0.01
Treatment
Number on prednisolone	8 (40)	7 (78)	ns
Prednisolone dose (mg/day), median (IQR)	5.0 (2.5–7.5)	7.5 (5.0–50.0)	0.02
DMARD	12 (60)	7 (78)	ns
Induction therapy (RTX and/or CYC)	1 (5)*	3 (33)†	0.08
RTX induction	1	1
RTX and CYC induction	0	1
CYC induction	0	1 (22)	0.05
RTX maintenance	7 (35)	1 (11)	ns

Data are shown as n or n (%), unless otherwise indicated.

*Received RTX only.

†One patient received RTX only, one combination RTX and CYC, and one CYC only.

COVID-19, coronavirus disease 2019; IQR, interquartile range; GPA, granulomatosis with polyangiitis; MPA, microscopic polyangiitis; EGPA, eosinophilic granulomatosis with polyangiitis; PR3, proteinase-3; MPO, myeloperoxidase; eGFR, estimated glomerular filtration rate; DMARD, disease-modifying anti-rheumatic drug; RTX, rituximab; CYC, cyclophosphamide; ns, not significant.

Figure 1. (A) Prednisolone dose (mg/day) in anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) patients with severe coronavirus disease 2019 (COVID-19) (n = 9) and non-severe COVID-19 (n = 20), and the rest of the cohort (n = 281); (B) estimated glomerular filtration rate (eGFR) (mL/min/1.73 m²) in AAV patients with severe COVID-19 (n = 9) and non-severe COVID-19 (n = 20), and the rest of the cohort (n = 281).