ACR/EULAR 2022 criteria improve prognostic prediction in AAV reclassification

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Below is a summary of the “Performance of the 2022 ACR/EULAR classification criteria compared to the European Medicines Agency algorithm in antineutrophil cytoplasmic antibody-associated vasculitis,” published in the September 2024 issue of rheumatology by Imai et al.

The 2022 American College of Rheumatology (ACR)/European Alliance of Associations for Rheumatology (EULAR) criteria provide an updated classification for antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV), resulting in a comparison with the algorithm of the European Medicines Agency (EMA) leads .

The researchers conducted a retrospective study to compare the 2022 ACR/EULAR classification criteria with the EMA algorithm for ANCA-AAV.

They examined all consecutive, newly diagnosed patients with AAV who attended Keio University Hospital (March 2012 and May 2022) according to the 2012 Chapel Hill Consensus Conference. According to the EMA algorithm and ACR/EULAR criteria 2022, patients were reclassified and statistically analyzed based on clinical characteristics.

The results showed 114 patients with AAV, using the EMA algorithm as a reference. Patient reclassification revealed ACR/EULAR 2022 sensitivity and specificity of 100% and 96% for eosinophilic granulomatosis with polyangiitis, 40% and 97% for granulomatosis with polyangiitis (GPA), and 90% and 49%, respectively, for microscopic polyangiitis (MPA). Approximately half of the patients classified as EMA-GPA or EMA-unclassifiable were reclassified as 2022-MPA.

Patients were older, had a higher likelihood of being positive for myeloperoxidase (MPO)-ANCA, and were more likely to have interstitial lung disease (ILD) than patients with 2022-GPA or non-2022-MPA. Some MPO-ANCA-positive patients with biopsy-proven granulomatous inflammation were also reclassified from EMA-GPA to 2022-MPA. In the mean observation period of 4.0 years, 16 patients died. The OS for each classification group differed significantly from the 2022 ACR/EULAR criteria (P=0.02), but not with the EMA algorithm (P=0.21).

The researchers found that patients classified as EMA-GPA or EMA-unclassifiable, older individuals with MPO-ANCA and ILD were often reclassified as 2022-MPA. The 2022 ACR/EULAR criteria were found to be more effective than the EMA algorithm for prognostic prediction.

Source: jrheum.org/content/early/2024/09/11/jrheum.2024-0335