Changes in serious infection and mortality among patients with ANCA-associated vasculitis during the COVID-19 pandemic: an interrupted time-series analysis of J-CANVAS

Objectives: In antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis, infection risk exceeds that of the general population, and infection is a leading cause of death.However, the impact of the COVID-19 pandemic on serious infections and mortality in this population remains uncertain.Methods: This observational study used data from the nationwide registry in Japan (Japan Collaborative Registry of ANCA-Associated Vasculitis), which includes patients with newly diagnosed and relapsed ANCA-associated vasculitis from 29 sites between January 2017 and March 2023.The primary outcome was serious infection requiring hospitalisation; the secondary outcome was all-cause mortality.The impact of COVID-19 was estimated using an interrupted timeseries analysis, with the boundary between April and May 2020 as the change point, following the first declaration of a state of emergency in Japan.Monthly incidence rates were modelled using segmented Poisson regression.Rate ratios (RRs) for level and slope changes with 95% CI were reported.Several sensitivity analyses were performed.Results: Among 1064 patients, total follow-up was 37,535 person-months; 205 serious infections and 96 deaths occurred.For serious infection, the level-change RR was 0.54 (95% CI: 0.31-0.94)and the slope-change RR was 1.01 (0.98-1.04).For all-cause mortality, the level-change RR was 0.35 (0.12-0.98) and the slope-change RR was 1.001 (0.94-1.06).Findings were robust across sensitivity analyses.Conclusions: Immediately after the onset of the COVID-19 pandemic, a clear reduction in serious infections and mortality was observed without major changes in patient characteristics.These findings may reflect the impact of social and personal infection control measures. WHAT IS ALREADY KNOWN ON THIS TOPICSeasonal infectious diseases declined in the general population during the COVID-19 pandemic, but whether similar changes occurred in serious infections and mortality among patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis was unknown. WHAT THIS STUDY ADDSIn a nationwide Japanese registry (Japan Collaborative Registry of ANCA-Associated Vasculitis), serious infections and allcause mortality in ANCA-associated vasculitis declined immediately after the onset of the COVID-19 pandemic.

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Journal
EULAR Rheumatology Open
Published
2026-04-01
DOI
https://doi.org/10.1016/j.ero.2026.03.013
Primary Topic
Vasculitis and related conditions
Type
article
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0.00

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article

Changes in serious infection and mortality among patients with ANCA-associated vasculitis during the COVID-19 pandemic: an interrupted time-series analysis of J-CANVAS

Naoho Takizawa, Naoto Azuma, Yutaka Kawahito, Kazuro Kamada et al.
EULAR Rheumatology Open
Vasculitis and related conditions
article

Changes in serious infection and mortality among patients with ANCA-associated vasculitis during the COVID-19 pandemic: an interrupted time-series analysis of J-CANVAS

Naoho Takizawa, Naoto Azuma, Yutaka Kawahito, Kazuro Kamada, Tomoaki Takata, Hiroaki Dobashi, Yasuhiro Shimojima, Naoya Kondo, Daiki Nakagomi, M. Kohno, Kazuki Fujioka, Yoshia Miyawaki, S. Hirata, Toshihiko Takada, Ryo Yanai, Yoshiyuki Abe, Atsushi Nomura, Koji Endo, Mayuko Moriyama, Takahiro Seno, Yusuke Matsuo, Toshiko Ito-Ihara, Tohru Takeuchi, Takashi Kida, Ryo Nishioka, Takafumi Ito, Nobuyuki Yajima, Ayuko Takatani, Ryota Okazaki, Takashi Kawaguchi, Yuji Kukida, Makoto Wada, Satoshi Omura, Hirosuke Takagi, Shoichi Fukui, Tsuyoshi Shirai, Isao Matsumoto
article en

Abstract

Objectives: In antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis, infection risk exceeds that of the general population, and infection is a leading cause of death.However, the impact of the COVID-19 pandemic on serious infections and mortality in this population remains uncertain.Methods: This observational study used data from the nationwide registry in Japan (Japan Collaborative Registry of ANCA-Associated Vasculitis), which includes patients with newly diagnosed and relapsed ANCA-associated vasculitis from 29 sites between January 2017 and March 2023.The primary outcome was serious infection requiring hospitalisation; the secondary outcome was all-cause mortality.The impact of COVID-19 was estimated using an interrupted timeseries analysis, with the boundary between April and May 2020 as the change point, following the first declaration of a state of emergency in Japan.Monthly incidence rates were modelled using segmented Poisson regression.Rate ratios (RRs) for level and slope changes with 95% CI were reported.Several sensitivity analyses were performed.Results: Among 1064 patients, total follow-up was 37,535 person-months; 205 serious infections and 96 deaths occurred.For serious infection, the level-change RR was 0.54 (95% CI: 0.31-0.94)and the slope-change RR was 1.01 (0.98-1.04).For all-cause mortality, the level-change RR was 0.35 (0.12-0.98) and the slope-change RR was 1.001 (0.94-1.06).Findings were robust across sensitivity analyses.Conclusions: Immediately after the onset of the COVID-19 pandemic, a clear reduction in serious infections and mortality was observed without major changes in patient characteristics.These findings may reflect the impact of social and personal infection control measures. WHAT IS ALREADY KNOWN ON THIS TOPICSeasonal infectious diseases declined in the general population during the COVID-19 pandemic, but whether similar changes occurred in serious infections and mortality among patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis was unknown. WHAT THIS STUDY ADDSIn a nationwide Japanese registry (Japan Collaborative Registry of ANCA-Associated Vasculitis), serious infections and allcause mortality in ANCA-associated vasculitis declined immediately after the onset of the COVID-19 pandemic.

EULAR Rheumatology Open
Kanazawa University (JP), SHOWA Medical University (JP), Tokyo Medical and Dental University (JP), Fukushima Medical University (JP), Shinshu University (JP), University of Tsukuba (JP), Tokyo University of Pharmacy and Life Sciences (JP), Okayama University (JP), Shimane University (JP), Kagawa University (JP), Hokkaido University (JP), Kyoto University (JP), Juntendo University (JP), Kyoto Prefectural University of Medicine (JP), St. Luke's International Hospital (JP), Chubu Rosai Hospital (JP), Sasebo City General Hospital (JP), Tohoku University Hospital (JP), University of Yamanashi Hospital (JP), Kagoshima University Hospital (JP), Hiroshima University Hospital (JP), Kure Kyosai Hospital (JP), Tottori Prefectural Central Hospital (JP), University Hospital Kyoto Prefectural University of Medicine (JP), Teikyo University Chiba Medical Center (JP), Kyoto Katsura Hospital (JP), Japanese Red Cross Society Kyoto Daini Hospital (JP), Institute of Applied Biochemistry (JP), Nagasaki University (JP), Tottori University (JP), Hyogo University (JP), Osaka University of Pharmaceutical Sciences (JP)
Bristol-Myers Squibb, Eli Lilly and Company, Pfizer, AstraZeneca, GlaxoSmithKline, Sanofi, Gilead Sciences, Kissei, Kaken Pharmaceutical, Eisai, Astellas Pharma, Mitsubishi Tanabe Pharma Corporation, Chugai Pharmaceutical, Japan Society for the Promotion of Science
Good health and well-being
Openalex Percentile: Top 20%
Vasculitis and related conditions
DOIOpen Access PDFOpenAlex
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