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. 2022 Jul 4:9:844112.
doi: 10.3389/fmed.2022.844112. eCollection 2022.

Do Relapses Follow ANCA Rises? A Systematic Review and Meta-Analysis on the Value of Serial ANCA Level Evaluation

Aram Al-Soudi  1   2 , Yosta Vegting  3 , Paul L Klarenbeek  1   2   4 , Marc L Hilhorst  3
Affiliations

Do Relapses Follow ANCA Rises? A Systematic Review and Meta-Analysis on the Value of Serial ANCA Level Evaluation

Aram Al-Soudi et al. Front Med (Lausanne). .

Abstract

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.

Keywords: ANCA-associated vasculitis (AAV); anti-neutrophil cytoplasmic antibodies (ANCA); biomarker (BM); flare; relapse.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Schematic overview of study selection procedure (12).
Figure 2
Figure 2
Meta-analysis summarizing the data regarding ANCA positivity once a relapse is diagnosed. Odds ratio with 95% confidence interval is displayed in the forest plot.
Figure 3
Figure 3
Meta-analysis summarizing the data regarding having a relapse when ANCA increases. Odds ratio with 95% confidence interval is displayed in the forest plot.
Figure 4
Figure 4
Meta-analysis summarizing the data regarding having a relapse within 6 months of an ANCA increase. Odds ratio with 95% confidence interval is displayed in the forest plot.
Figure 5
Figure 5
Meta-analysis summarizing the data regarding having a relapse within 12 months of an ANCA increase. Odds ratio with 95% confidence interval is displayed in the forest plot.
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