Do Relapses Follow ANCA Rises? A Systematic Review and Meta-Analysis on the Value of Serial ANCA Level Evaluation
ObjectivesANCA-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...
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Frontiers Media S.A.
2022-07-01
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| Series: | Frontiers in Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fmed.2022.844112/full |
| _version_ | 1818235637076066304 |
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| author | Aram Al-Soudi Aram Al-Soudi Yosta Vegting Paul L. Klarenbeek Paul L. Klarenbeek Paul L. Klarenbeek Marc L. Hilhorst |
| author_facet | Aram Al-Soudi Aram Al-Soudi Yosta Vegting Paul L. Klarenbeek Paul L. Klarenbeek Paul L. Klarenbeek Marc L. Hilhorst |
| author_sort | Aram Al-Soudi |
| collection | DOAJ |
| description | ObjectivesANCA-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.Methods3 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.ResultsTwenty 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%).ConclusionIn 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. |
| first_indexed | 2024-12-12T11:57:08Z |
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| id | doaj.art-5ae4028aadf345948b7da646681e42d3 |
| institution | Directory Open Access Journal |
| issn | 2296-858X |
| language | English |
| last_indexed | 2024-12-12T11:57:08Z |
| publishDate | 2022-07-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Medicine |
| spelling | doaj.art-5ae4028aadf345948b7da646681e42d32022-12-22T00:25:11ZengFrontiers Media S.A.Frontiers in Medicine2296-858X2022-07-01910.3389/fmed.2022.844112844112Do Relapses Follow ANCA Rises? A Systematic Review and Meta-Analysis on the Value of Serial ANCA Level EvaluationAram Al-Soudi0Aram Al-Soudi1Yosta Vegting2Paul L. Klarenbeek3Paul L. Klarenbeek4Paul L. Klarenbeek5Marc L. Hilhorst6Department of Rheumatology, Amsterdam UMC, University of Amsterdam, Amsterdam, NetherlandsRheumatology and Immunology Center (ARC), Amsterdam UMC, University of Amsterdam, Amsterdam, NetherlandsDepartment of Internal Medicine, Section of Nephrology, Amsterdam UMC, University of Amsterdam, Amsterdam, NetherlandsDepartment of Rheumatology, Amsterdam UMC, University of Amsterdam, Amsterdam, NetherlandsRheumatology and Immunology Center (ARC), Amsterdam UMC, University of Amsterdam, Amsterdam, NetherlandsDepartment of Rheumatology, Spaarne Gasthuis, Hoofddorp, NetherlandsDepartment of Internal Medicine, Section of Nephrology, Amsterdam UMC, University of Amsterdam, Amsterdam, NetherlandsObjectivesANCA-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.Methods3 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.ResultsTwenty 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%).ConclusionIn 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.https://www.frontiersin.org/articles/10.3389/fmed.2022.844112/fullANCA-associated vasculitis (AAV)anti-neutrophil cytoplasmic antibodies (ANCA)biomarker (BM)relapseflare |
| spellingShingle | Aram Al-Soudi Aram Al-Soudi Yosta Vegting Paul L. Klarenbeek Paul L. Klarenbeek Paul L. Klarenbeek Marc L. Hilhorst Do Relapses Follow ANCA Rises? A Systematic Review and Meta-Analysis on the Value of Serial ANCA Level Evaluation Frontiers in Medicine ANCA-associated vasculitis (AAV) anti-neutrophil cytoplasmic antibodies (ANCA) biomarker (BM) relapse flare |
| title | Do Relapses Follow ANCA Rises? A Systematic Review and Meta-Analysis on the Value of Serial ANCA Level Evaluation |
| title_full | Do Relapses Follow ANCA Rises? A Systematic Review and Meta-Analysis on the Value of Serial ANCA Level Evaluation |
| title_fullStr | Do Relapses Follow ANCA Rises? A Systematic Review and Meta-Analysis on the Value of Serial ANCA Level Evaluation |
| title_full_unstemmed | Do Relapses Follow ANCA Rises? A Systematic Review and Meta-Analysis on the Value of Serial ANCA Level Evaluation |
| title_short | Do Relapses Follow ANCA Rises? A Systematic Review and Meta-Analysis on the Value of Serial ANCA Level Evaluation |
| title_sort | do relapses follow anca rises a systematic review and meta analysis on the value of serial anca level evaluation |
| topic | ANCA-associated vasculitis (AAV) anti-neutrophil cytoplasmic antibodies (ANCA) biomarker (BM) relapse flare |
| url | https://www.frontiersin.org/articles/10.3389/fmed.2022.844112/full |
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