Antibody subtypes and titers predict clinical outcomes in ANCA-associated vasculitis


The objective of this study is to evaluate the association between antineutrophil cytoplasmic autoantibody (ANCA) subtype and ANCA titers on clinical outcomes and disease activity among a cohort of patients from Central Appalachia diagnosed with ANCA-associated vasculitis (AAV) over a 3-decade period. This is a retrospective chart review of all patients diagnosed with AAV. ANCA subtypes (myeloperoxidase (MPO) and proteinase 3 (PR3)) and titers at the time of diagnosis and at the time of relapse or last follow-up were evaluated along with patient outcomes. Outcomes of interest included relapse, development of end-stage renal disease (ESRD) and mortality. Sensitivity analysis and multivariable analysis were performed. Of the 202 patients, 111 patients were MPO-ANCA positive and 91 patients were PR3-ANCA positive. Relapse was more frequent among patients with PR3-ANCA compared to MPO-ANCA (35% vs 12%, p < 0.001). In both ANCA subgroups, the strongest predictor of relapse was an increase in titers prior to relapse, HR 8.1 (95% CI 1.6–40), p 0.009. Patients who achieved serological remission had a lower risk of ESRD [sub-HR 0.31 (95% CI 0.11–0.89)] and mortality [HR (95% CI) 0.24 (0.07–0.7)]. PR3-ANCA was associated with higher risk of ESRD [sub-HR 3.1 (95% CI 1.1–8.5)]. There was no difference in mortality between patients with MPO-ANCA and PR3-ANCA. Our study supports the use of both ANCA subtypes and titer levels for predicting clinical outcomes in patients receiving treatment for AAV. Monitoring of ANCA antibody titers may be useful since both serological remission and increase in titers provide prognostic information.

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Author information




MA: conducted the literature search for the background of the study, collected, analyzed and interpreted statistical data, wrote the majority of the manuscript; DM: contributed to the design and data collection, the analysis of the results and the writing of the manuscript; AH: contributed to the data collection; JT: contributed to the design, analysis of results and interpreting statistical data; BP and RS: contributed to the analysis of the results and the writing of the manuscript; KS: contributed to the data collection, analyzed, interpreted statistical data and writing of the manuscript; DK: contributed to the design of the study, the collection of data, analysis of the results and the writing of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Dinesh Kannabhiran.

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The authors declare that they have no conflict of interest.

Ethical statement

This retrospective chart review study involving human participants was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The Human Investigation Committee (IRB) of West Virginia University approved this study. IRB approval number: 1905572870.

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Aljuhani, M., Makati, D., Hoff, A. et al. Antibody subtypes and titers predict clinical outcomes in ANCA-associated vasculitis. Rheumatol Int (2021).

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  • ANCA-associated vasculitis
  • Clinical outcomes
  • End-stage renal disease
  • Relapse
  • Mortality
  • ANCA subtypes
  • ANCA titers
  • Serological remission