COVID-19 and ANCA-associated vasculitis: recommendations for vaccine preparedness and the use of rituximab.
COVID-19 and ANCA-associated vasculitis: recommendations for vaccine preparedness and the use of rituximab.
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DOI：
10.1093/ndt/gfab174
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发表时间：
2021-08-27
期刊：
影响因子：
--
通讯作者：
Szpirt WM
中科院分区：
文献类型：
--
作者：
Bruchfeld A;Kronbichler A;Alberici F;Fervenza FC;Jayne DRW;Segelmark M;Tesar V;Szpirt WM
2019冠状病毒病（COVID-19）流行一年来，有关免疫介导的肾脏疾病和抗中性粒细胞胞质抗体相关血管炎（AAV）患者更详细的风险特征和治疗方面的数据仍然很少。肾小球肾炎中COVID感染的国际登记处报告了40例原发性肾小球肾炎患者，包括AAV。与80例住院对照组相比，肾小球肾炎患者的死亡率和急性肾脏病发生率显著较高[1]。英国和爱尔兰血管炎协会对65例血管炎患者进行的分析发现，合并呼吸系统疾病与糖皮质激素处方之间存在关联，导致严重结局（补充数据，表S1）[2]。一些治疗数据可从风湿病注册研究中获得。法国报告了694例患有炎症性风湿性和肌肉骨骼疾病的COVID-19患者的免疫抑制和结局。年龄较大、合并症（包括慢性肾病（CKD））和使用糖皮质激素10 mg/天或等效药物（泼尼松）或利妥昔单抗与COVID-19的严重程度相关[3]。在COVID-19全球流变学联盟最近发表的3729例严重急性呼吸综合征冠状病毒2（SARS-CoV-2）感染患者中，年龄较大、男性、CKD和其他合并症与COVID-19相关死亡相关，发生率为10.5%。疾病特异性因素，如中度/高度疾病活动、血管炎诊断和药物（如利妥昔单抗）与死亡率相关（补充数据，表S1）[4]。这些研究均未报告诱导或维持治疗之间的差异。在现实生活中，利妥昔单抗在大流行期间经常被推迟，以减轻严重SARS-CoV-2感染的风险。206例研究的AAV患者中有21例推迟了利妥昔单抗维持治疗。这些病例中有12例发生疾病复发或复发。强调了护理中断，因为这可能导致复发诊断延迟[5]。这些最近的发现强调，利妥昔单抗治疗的患者有发生严重COVID-19的风险，但需要维持有效的治疗以降低AAV疾病复发的风险。
One year into the coronavirus disease 2019 (COVID-19) epidemic, data regarding a more detailed risk profile and treatment aspects of patients with immune-mediated kidney diseases and anti-neutrophil cytoplasmic antibody–associated vasculitis (AAV) have remained scarce. The International Registry of COVID infection in glomerulonephritis reported 40 patients with primary glomerulonephritis including AAV. Compared with 80 hospitalized controls, mortality and acute kidney rates were significantly higher in patients with glomerulonephritis [1]. A UK and Ireland Vasculitis Society analysis of 65 vasculitis patients found associations between comorbid respiratory disease and prescription of glucocorticoids with severe outcomes (Supplementary data, Table S1)[2]. Some treatment data are available from rheumatology registry studies. Immunosuppression and outcomes of 694 COVID-19 patients with inflammatory rheumatic and musculoskeletal diseases was reported from France. Older age, comorbidities including chronic kidney disease (CKD) and the use of glucocorticoids 10mg/day or equivalent (prednisone) or rituximab were associated with COVID-19 severity [3]. In a recent publication from the COVID-19 Global Rheumatology Alliance of 3729 severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-infected patients, older age, male sex, CKD and other comorbidities were associated with COVID-19-related death, which occurred in 10.5%. Disease-specific factors such as moderate/high disease activity, a diagnosis of vasculitis and drugs such as rituximab were associated with mortality (Supplementary data, Table S1)[4]. In neither of these studies were differences between induction or maintenance treatment reported. In a real-life setting, rituximab has frequently been postponed during the pandemic to mitigate the risk of severe SARS-CoV-2 infections. Twenty-one of 206 studied patients with AAV had their rituximab maintenance treatment postponed. Relapses or flares of disease occurred in 12 of these cases. The disruption of care was highlighted, as this may have contributed to delayed relapse diagnosis [5]. These recent findings underline that rituximab-treated patients are at risk of developing severe COVID-19, but effective treatment needs to be maintained to reduce the risk of disease relapse in AAV.
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DOI：
10.1002/art.41728
发表时间：
2021-09
期刊：
Arthritis & rheumatology (Hoboken, N.J.)
影响因子：
--
作者：
Rutherford MA;Scott J;Karabayas M;Antonelou M;Gopaluni S;Gray D;Barrett J;Brix SR;Dhaun N;McAdoo SP;Smith RM;Geddes CC;Jayne D;Luqmani R;Salama AD;Little MA;Basu N;UK and Ireland Vasculitis Rare Disease Group (UKIVAS)
通讯作者：
UK and Ireland Vasculitis Rare Disease Group (UKIVAS)
影响因子：
4.6
作者：
Westra, J.;van Assen, S.;Bijl, M.
通讯作者：
Bijl, M.
影响因子：
1.9
作者：
Gapud, Eric J.;Kronbichler, Andreas;Geetha, Duvuru
通讯作者：
Geetha, Duvuru
影响因子：
19.6
作者：
Waldman M;Soler MJ;García-Carro C;Lightstone L;Turner-Stokes T;Griffith M;Torras J;Valenzuela LM;Bestard O;Geddes C;Flossmann O;Budge KL;Cantarelli C;Fiaccadori E;Delsante M;Morales E;Gutierrez E;Niño-Cruz JA;Martinez-Rueda AJ;Comai G;Bini C;La Manna G;Slon MF;Manrique J;Agraz I;Sinaii N;Cravedi P
通讯作者：
Cravedi P
影响因子：
64.8
作者：
Combes AJ;Courau T;Kuhn NF;Hu KH;Ray A;Chen WS;Chew NW;Cleary SJ;Kushnoor D;Reeder GC;Shen A;Tsui J;Hiam-Galvez KJ;Muñoz-Sandoval P;Zhu WS;Lee DS;Sun Y;You R;Magnen M;Rodriguez L;Im KW;Serwas NK;Leligdowicz A;Zamecnik CR;Loudermilk RP;Wilson MR;Ye CJ;Fragiadakis GK;Looney MR;Chan V;Ward A;Carrillo S;UCSF COMET Consortium;Matthay M;Erle DJ;Woodruff PG;Langelier C;Kangelaris K;Hendrickson CM;Calfee C;Rao AA;Krummel MF
通讯作者：
Krummel MF