AB0606 Health-related quality of life in patients with rituximab-induced remission of ANCA-associated vasculitis: registry-based cohort studies

Background

Survival rate in ANCA-associated vasculitis (AAV) has significantly improved due to anti-B cell therapy with rituximab (RTX). The main issue now appears to be the management of comorbidities and the improvement of quality of life.

Objectives

Based on a prospective analysis of the single centre registry of AAV patients (pts) treated with RTX, to study the impact of sustained remission on health-related quality of life using Short-Form 36 (SF-36).

Methods

Health-related quality of life was assessed in 70 AAV pts: 35 (50%) with granulomatosis with polyangiitis (GPA), 24 (34.3%) - microscopic polyangiitis (MPA) and 11 (15,7%) - eosinophilic granulomatosis with polyangiitis (EGPA). The mean age was 49,7 ± 15,7 years, 53% women. The median total dose of RTX was 4.3± 2,5 g. As a rule, a reduced dose of RTX 500 mg was used for repeated courses. Mean duration of RTX therapy 46.8 ± 29.4 months. Remission of AAV was defined as a Birmingham Vasculitis Activity Score = 0 regardless of prednisone treatment or dosage. All pts were in remission.

Results

In 70 patients the average indicators of physical functioning: MPA 62.5 (47.5, 78.8), GPA 75 (55, 92.5), EGPA 60 (45, 77.5); social functioning: MPA 25 (0, 56.3), GPA 50 (25, 100), EGPA 50 (12.5, 62.5), physical health component: MPA 41.6 (31.5, 44.8), GPA 43.7 (36.7, 52.5), EGPA 38.7 (33.8, 45). There were no significant differences between men and women within the GPA, MPA, and EGPA groups. There were also no differences between different age groups. When comparing the EGPA group with GPA or MPA, no significant differences were found. At the same time, in patients with MPA, the indicators of physical functioning (p=0.015, w= 3.92) and the physical component of health (p=0.012, w 4.026) were significantly lower than in patients with GPA.

Conclusion

RTX maintenance allows to achieve a good quality of life in AAV pts. SF-36 summary measures were significantly higher in GPA pts compared with MPA. Further research is required to analyze the effect of AAV phenotype and complications on health-related quality of life.

References

[1]V.N. Amirdzhanova, D.V. Goryachev, N.I. Korshunov, et al. Population indicators of the quality of life according to the SF-36 questionnaire (results of the multicenter study of the quality of life “MIRAGE”) SCIENTIFIC AND PRACTICAL RHEUMATOLOGY No. 1, 2008. https://doi.org/10.14412/1995-4484-2008-3

[2]Yun, JD., Ha, J., Kim, S. et al. Predictor of depressive disorders in patients with antineutrophil cytoplasmic antibody-associated vasculitis. Clin Rheumatol 38, 3485–3491 (2019). https://doi.org/10.1007/s10067-019-04657-4

Disclosure of Interests

None declared

AB0670 THE COURSE AND OUTCOMES OF COVID-19 IN PATIENTS WITH ANCA-ASSOCIATED SYSTEMIC VASCULITIS, RECEIVING ANTI-B CELL THERAPY WITH RITUXIMAB

Background:

Currently, the issues of the effect of anti-B cell therapy on the risk of severe course of COVID-19 in patients (pts) with ANCA-associated vasculitis (AAV) has not been completely studied.

Objectives:

We present an analysis of the COVID-19 incidence and outcomes in 126 AAV pts treated with rituximab (RTX) from one rheumatology center registry.

Methods:

Data were collected with telephone/online surveying between 11-15th November 2020 from all 126 AAV pts (58- granulomatosis with polyangiitis, GPA; 38- microscopic polyangiitis, MPA; 22- eosinophilic granulomatosis with polyangiitis, EGPA (54% ANCA-negative); and 8- uncertain AAV). Pts age was 51 (20-81) yr, 62% women. Due to AAV activity or risk of relapse, during the pandemic RTX was prescribed in 48% pts.

Results:

The incidence of COVID-19 in AAV pts was 3.5% during the first 3 months of the pandemic, the course was uneventful, and all pts recovered. Since September 2020 a 4-fold increase in the incidence alongside with more severe course of COVID-19 were reported. After 8 months of the pandemic, COVID-19 was diagnosed in 21 (16.6%) pts with median age 55 yr, 57% women. COVID-19 incidence was lower in GPA (15.5%) vs MPA (21.1%) or EGPA (27.7%). The mortality rate was 14.3% (2- MPA, 1- GPA). When analyzing the 5-year survival rate of AAV pts treated with RTX, prognosis worsening was noted; in 2020 there were 3 deaths due to COVID-19, in the previous 5 years- only 2 deaths.

Conclusion:

Taking into account the fact the mechanisms of AAV and severe COVID-19 are largely synergistic (Table 1), primarily in the context of obstructive thromboinflammation as manifestation of acute inflammatory syndrome in COVID-19 [1], AAV can potentially contribute to the severe course of COVID-19. Anti-CD20 therapy seems to have a protective effect against severe COVID-19 [2], which, however, can be insufficient in AAV pts with active disease and multiple organ damage. Further analysis of COVID-19 cases in pts with AAV and other rheumatic diseases is exceptionally important.

Table 1.

Comparison of AAV and severe COVID-19

ParameterAAVSevere COVID-19Lung damageHigh frequency of lung damagePossibly destructive lung damageDamage to other organsTypically affects the upper and lower airways and kidneys; Other organs can be involvedPossible extrapulmonary localizationVascular involvementSystemic necrotizing vasculitis of small vessels; In the active phase, hypercoagulationObstructive thromboinflammation of the microcirculation of lungs and extrapulmonary vessels; Increased incidence of Kawasaki syndrome during the pandemicInflammationHigh or very highVery highAutoantibodiesANCA pathogenetic roleDominant extrafollicular B cell responses; Сorrelation between SARS-CoV-2 antibody titer and severity of COVID-19; High titers of IFN-α2/ω autoantibodiesNeutrophilNeutrophils are the most important effector cells in the pathogenesisChanges in the morphology of neutrophils were noted; Netosis, the release of proteases from neutrophils promote the complement system activation, hypercoagulation, endotheliitis, production of pro-inflammatory cytokines; An increase of neutrophils in the blood and bronchoalveolar lavage fluid were notedComplementComplement is crucial in the pathogenesis; C5a receptor antagonist Avacopan efficacyActivation of alternative/lectin complement pathways; C5 antagonist Eculizumab has been reported to be effectiveTreatmentImmunosuppressants; In the active phase, anticoagulantsAnticoagulants; Glucocorticoids, pro-inflammatory cytokine antagonists, JAK inhibitors, cyclosporinePrognosisSeriousHigh mortality rate

References:

[1]Ciceri F, et al. Microvascular COVID-19 lung vessels obstructive thromboinflammatory syndrome (MicroCLOTS): an atypical acute respiratory distress syndrome working hypothesis. Crit Care Resusc. 2020;22(2):95-7

[2]Montero-Escribano P, et al. Anti-CD20 and COVID-19 in multiple sclerosis and related disorders: A case series of 60 patients from Madrid, Spain. Mult Scler Relat Disord. 2020;42:102185

Disclosure of Interests:

None declared

Determining the effects and challenges of incorporating genetic testing into primary care management of hypertensive patients with African ancestry

People of African ancestry (Blacks) have increased risk of kidney failure due to numerous socioeconomic, environmental, and clinical factors. Two variants in the APOL1 gene are now thought to account for much of the racial disparity associated with hypertensive kidney failure in Blacks. However, this knowledge has not been translated into clinical care to help improve patient outcomes and address disparities. GUARDD is a randomized trial to evaluate the effects and challenges of incorporating genetic risk information into primary care. Hypertensive, non-diabetic, adults with self-reported African ancestry, without kidney dysfunction, are recruited from diverse clinical settings and randomized to undergo APOL1 genetic testing at baseline (intervention) or at one year (waitlist control). Providers are educated about genomics and APOL1. Guided by a genetic counselor, trained staff return APOL1 results to patients and provide low-literacy educational materials. Real-time clinical decision support tools alert clinicians of their patients' APOL1 results and associated risk status at the point of care. Our academic-community-clinical partnership designed a study to generate information about the impact of genetic risk information on patient care (blood pressure and renal surveillance) and on patient and provider knowledge, attitudes, beliefs, and behaviors. GUARDD will help establish the effective implementation of APOL1 risk-informed management of hypertensive patients at high risk of CKD, and will provide a robust framework for future endeavors to implement genomic medicine in diverse clinical practices. It will also add to the important dialog about factors that contribute to and may help eliminate racial disparities in kidney disease.