ABSTRACT
Background: ANCA-associated glomerulonephritis (ANCA-GN) is a complex disease with high risk of mortality and morbidity. Although the cause of disease is commonly not identified, infections and environmental exposures have been observed. The COVID-19 pandemic has increased concerns about immunologic risk, with postvaccination diagnosis highlighted in several case reports. We aimed to evaluate the changes in incidence and clinical/histopathological profile of ANCA-GN over time, comparing a historical cohort to recent cases in the COVID era. Method(s): We conducted a retrospective review of patients with a pathologic diagnosis of ANCA-GN at the University of Rochester from 1/1/15 to 11/1/21. Data obtained included biopsy reports, laboratory findings, comorbidities, COVID vaccination status, and demographics. The 2015-2020 cohort was compared to the 2021 cohort. Result(s): 65 subjects were included, including 54 from 2015-2020 and 11 from 2021, with a consistent incidence of 10-11 diagnoses per year. There was no significant difference in age, sex, race, or geographic region between cohorts, and no difference in histopathological findings. Clinical variables were similar between groups. Among the 11 subjects diagnosed in 2021, 6 received COVID vaccination before diagnosis, 2 were unvaccinated at diagnosis, and 3 were unknown. Two subjects received vaccination within 60 days of diagnosis and the remainder were >90 days from vaccination. Conclusion(s): There was no significant difference in the incidence of ANCA-GN between the historical cohort of patients and those diagnosed in 2021. The histopathologic and biochemical profile did not differ significantly. There was no temporal relationship noted between vaccine timing and disease onset in the post-COVID cohort. (Table Presented).
ABSTRACT
Introduction: Phototherapy is an effective, economic dermatologic treatment with few side effects. Home phototherapy has the potential to overcome barriers that patients face in accessing care (e.g., frequent clinic visits, travel, co-pays, etc.). This study evaluated the feasibility and acceptability of a home phototherapy program at the University of Rochester. Methods: A retrospective review of electronic medical records and a telephone survey were conducted of all adult patients (≥18 years) prescribed home phototherapy for a dermatologic condition (2019-2021). Data collected from chart review included demographics and disease course. Telephone surveys consisted of 12 questions regarding device use, Perceived Global Impression of Severity (PGIS), Skindex-mini, satisfaction with care, and treatment preference. Institutional review board approval was obtained. Results: Of 63 eligible subjects, 43 (68%) participated in the survey (n = 23 psoriasis, n = 11 atopic dermatitis, n = 9 with other diseases). The average disease severity on PGIS at the time of survey was 2.72 (mild). Most subjects surveyed (88.4%) felt their disease had improved since initiating home phototherapy. All subjects preferred home therapy to in-office phototherapy due to the convenience (74.4%), distance they lived from clinic (27.9%), reduced cost (23.3%), work and household obligations (20.9%), privacy (14.0%), and COVID-19 related concerns (14.0%). Notably, 18.6% experienced side effects, most commonly erythema. Discussion: Home phototherapy is safe and effective, particularly for patients who have difficulty obtaining in-office care. It also presents a promising alternative to in-person care during the COVID-19 pandemic. Insurance carriers can save significant funds by instituting such programs and avoiding more costly systemic therapies.