The impact of COVID-19 pandemic on patients with ANCA associated vasculitis
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ORIGINAL ARTICLE
The impact of COVID‑19 pandemic on patients with ANCA associated vasculitis Sam Kant1 · Adam Morris2 · Srekar Ravi3 · Lauren Floyd2 · Eric Gapud4 · Brendan Antichos4 · Ajay Dhaygude2 · Phil Seo4 · Duvuru Geetha1,4 Received: 11 August 2020 / Accepted: 27 September 2020 © Italian Society of Nephrology 2020
Abstract Introduction The coronavirus 2019 (COVID-19) pandemic has brought on challenges not only to acute care, but also chronic care of patients. Individuals maintained on immunosuppression appear to be especially susceptible to COVID-19 infection. Patients with ANCA-associated vasculitis (AAV) frequently require immunosuppression and may be at increased risk for developing COVID-19. The incidence and impact of COVID-19 on patients with AAV is currently not known. We aimed to investigate this impact via a telephone questionnaire-based patient survey and chart review. Methods A cross-sectional study of AAV patients followed at two centers was conducted. Data regarding demographics, disease characteristics and therapy were confirmed by chart review. A telephone survey was conducted to ascertain symptoms and contact exposure related to COVID-19, as well as changes in health care delivery during the pandemic period between January and July, 2020. Results Of the 206 patients surveyed, the median age was 64 years, 51% were female and mean (SD) disease duration was 7 (5) years. The majority had kidney (n = 160) and lung (n = 108) involvement. Seventy-five percent (n = 155) were receiving immunosuppression, with 77 patients (50%) receiving rituximab during the pandemic period. Of the 10 patients tested for severe acute respiratory syndrome coronavirus 2 (SARS CoV-2) by PCR, three were positive. Patients had a significant disruption in care; none had an in-person visit and 69% had a telemedicine consultation. Rituximab maintenance was postponed in 21 patients. Twelve patients experienced disease relapse. Conclusion The incidence of COVID-19 in patients with AAV appears to be similar to that of the general population. For a patient population that requires active clinical surveillance, there is significant disruption in care as a result of the pandemic. Reduction of immunosuppression may not be indicated, and the risk of relapse likely far outweighs the risk of COVID-19.
Introduction
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s40620-020-00881-3) contains supplementary material, which is available to authorized users. * Duvuru Geetha [email protected] 1
Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
2
Royal Preston Hospital, Lancashire, UK
3
Florida Atlantic University, Boca Raton, FL, USA
4
Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
As the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) disease 2019 (COVID-19) pandemic has evolved, there is concern that immunosuppressed patients, i
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