TY - JOUR
T1 - Do Relapses Follow ANCA Rises? A Systematic Review and Meta-Analysis on the Value of Serial ANCA Level Evaluation
AU - Al-Soudi, Aram
AU - Vegting, Yosta
AU - Klarenbeek, Paul L.
AU - Hilhorst, Marc L.
N1 - Funding Information: This work was supported by the Dutch Kidney Foundation [Grant number 19OK007 to MH and YV] and ZonMW [VENI grant number 91617058 to PK]. Publisher Copyright: Copyright © 2022 Al-Soudi, Vegting, Klarenbeek and Hilhorst.
PY - 2022/7/4
Y1 - 2022/7/4
N2 - Objectives: ANCA-vasculitis (AAV) patients frequently suffer from relapses and risk subsequent organ damage. There is much debate on the value of serial ANCA level evaluation to monitor disease activity. We aimed to evaluate the association between ANCA rises and disease relapses at (I) moment of the rise, (II) within 6 months or (III) within a year from the rise. Methods: 3 databases (MEDLINE, EMBASE, COCHRANE) were searched from 1993 through September 2021. We included studies that reported relapse incidence within 12 months after an ANCA rise measured by antigen-specific immunoassays in peripheral blood of AAV patients in remission. Quality assessment was performed using QUADAS-2. Finally, a meta-analysis was carried out to estimate average OR using a random effects model. Results: Twenty unique studies were included. The methodological quality was limited due to risk of selection bias. An ANCA rise often preceded a disease relapse within 6 months (OR 3.65, 95% CI 1.66–8.03) and less often within 12 months (OR 2.88, 95% CI 1.21–6.88), while it was not indicative of a concurrent relapse (OR 0.13, 95% CI 0.03–0.53). Once a relapse is diagnosed, ANCA is significantly more often present than not (OR 10.80, 95% CI 3.82–30.55). As expected based on clinical, technical and methodological variability between studies, there was substantial heterogeneity across studies in all analyses (I2 = 70–87%). Conclusion: In previously ANCA-positive patients, the ANCA test is often positive upon clinical suspicion of a disease relapse. Patients with a rise in ANCA are at risk of encountering disease relapses in the upcoming 6 or 12 months.
AB - Objectives: ANCA-vasculitis (AAV) patients frequently suffer from relapses and risk subsequent organ damage. There is much debate on the value of serial ANCA level evaluation to monitor disease activity. We aimed to evaluate the association between ANCA rises and disease relapses at (I) moment of the rise, (II) within 6 months or (III) within a year from the rise. Methods: 3 databases (MEDLINE, EMBASE, COCHRANE) were searched from 1993 through September 2021. We included studies that reported relapse incidence within 12 months after an ANCA rise measured by antigen-specific immunoassays in peripheral blood of AAV patients in remission. Quality assessment was performed using QUADAS-2. Finally, a meta-analysis was carried out to estimate average OR using a random effects model. Results: Twenty unique studies were included. The methodological quality was limited due to risk of selection bias. An ANCA rise often preceded a disease relapse within 6 months (OR 3.65, 95% CI 1.66–8.03) and less often within 12 months (OR 2.88, 95% CI 1.21–6.88), while it was not indicative of a concurrent relapse (OR 0.13, 95% CI 0.03–0.53). Once a relapse is diagnosed, ANCA is significantly more often present than not (OR 10.80, 95% CI 3.82–30.55). As expected based on clinical, technical and methodological variability between studies, there was substantial heterogeneity across studies in all analyses (I2 = 70–87%). Conclusion: In previously ANCA-positive patients, the ANCA test is often positive upon clinical suspicion of a disease relapse. Patients with a rise in ANCA are at risk of encountering disease relapses in the upcoming 6 or 12 months.
KW - ANCA-associated vasculitis (AAV)
KW - anti-neutrophil cytoplasmic antibodies (ANCA)
KW - biomarker (BM)
KW - flare
KW - relapse
UR - http://www.scopus.com/inward/record.url?scp=85134419713&partnerID=8YFLogxK
U2 - https://doi.org/10.3389/fmed.2022.844112
DO - https://doi.org/10.3389/fmed.2022.844112
M3 - Review article
C2 - 35860735
SN - 2296-858X
VL - 9
JO - Frontiers in Medicine
JF - Frontiers in Medicine
M1 - 844112
ER -