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. 2025 Jun 13;61(6):1088.
doi: 10.3390/medicina61061088.

Impact of Early MPO-ANCA Positivity on Unique Clinical Features in Korean Patients with EGPA: A Single-Centre Cohort Study

Oh Chan Kwon  1 , Jang Woo Ha  2 , Min-Chan Park  1 , Yong-Beom Park  3   4 , Sang-Won Lee  3   4
Affiliations

Impact of Early MPO-ANCA Positivity on Unique Clinical Features in Korean Patients with EGPA: A Single-Centre Cohort Study

Oh Chan Kwon et al. Medicina (Kaunas). .

Abstract

Objectives: Previous studies have suggested differences in vasculitic and eosinophilic phenotypes based on anti-neutrophil cytoplasmic antibody (ANCA) positivity in eosinophilic granulomatosis with polyangiitis (EGPA). However, their relevance under the 2022 American College of Rheumatology (ACR)/European Alliance of Associations for Rheumatology (EULAR) classification criteria remains unclear. We aimed to evaluate the clinical features and outcomes of EGPA according to myeloperoxidase (MPO)-ANCA status in a Korean cohort. Methods: We conducted a retrospective cohort study that included 57 patients with EGPA without proteinase 3-ANCA positivity who fulfilled the 2022 ACR/EULAR classification criteria. Patients were classified into MPO-ANCA-positive (n = 25) and MPO-ANCA-negative (n = 32) groups. Clinical manifestations, laboratory findings, and outcomes, including all-cause mortality, relapse, end-stage kidney disease (ESKD), cerebrovascular accident (CVA), and acute coronary syndrome (ACS), were compared between the two groups. Results: MPO-ANCA-positive patients exhibited higher Five-Factor Scores (1.0 [0.0-1.0] vs. 0.0 [0.0-1.0], p = 0.038), lower Short Form 36 Physical Component Summary scores (35.0 [19.7-56.3] vs. 52.5 [43.5-69.7], p = 0.048), and elevated systemic inflammation markers (higher erythrocyte sedimentation rate: 58.0 [16.0-97.5] mm/hr vs. 25.5 [7.0-63.8] mm/hr, p = 0.026). Constitutional symptoms were more frequent among MPO-ANCA-positive patients (n = 14 [56.0%] vs. n = 3 [9.4%], p < 0.001), whereas no significant differences were found in vasculitic or eosinophilic manifestations. Kaplan-Meier analysis revealed no differences in the overall (p = 0.36), relapse-free (p = 0.80), ESKD-free (p = 0.87), CVA-free (p = 0.26), or ACS-free (p = 0.94) survival rates between the two groups. Conclusions: In Korean patients with EGPA classified under the 2022 ACR/EULAR classification criteria, MPO-ANCA positivity, as compared to ANCA-negative status, was associated with a higher disease burden and poorer quality of life but not with distinct vasculitic or eosinophilic manifestations and adverse outcomes.

Keywords: anti-neutrophil cytoplasmic antibody; clinical; feature; myeloperoxidase; vasculitis.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Kaplan-Meier analysis showing cumulative (A) survival rate, (B) relapse-free survival rate, (C) ESKD-free survival rate, (D) CVA-free survival rate, and (E) ACS-free survival rate according to MPO-ANCA status. ACS: acute coronary syndrome; ANCA: anti-neutrophil cytoplasmic antibody; CVA: cerebrovascular accident; ESKD: end-stage kidney disease; MPO: myeloperoxidase.
Figure 1
Figure 1
Kaplan-Meier analysis showing cumulative (A) survival rate, (B) relapse-free survival rate, (C) ESKD-free survival rate, (D) CVA-free survival rate, and (E) ACS-free survival rate according to MPO-ANCA status. ACS: acute coronary syndrome; ANCA: anti-neutrophil cytoplasmic antibody; CVA: cerebrovascular accident; ESKD: end-stage kidney disease; MPO: myeloperoxidase.
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