Avacopan for anti-neutrophil cytoplasm antibodies-associated vasculitis: a multicentre real-world study.
A French real-world study of avacopan used outside clinical trials, including patients with severe kidney vasculitis and glucocorticoid contraindications, found most patients achieved a favorable outcome with rapid steroid tapering and improved kidney function.
Background
Avacopan, a selective C5aR1 inhibitor, is a glucocorticoid-sparing agent for ANCA-associated vasculitis (AAV), but data outside randomized trials, particularly in patients with severe kidney involvement or glucocorticoid contraindications, remain limited.
Study design
This multicenter retrospective study reviewed 31 patients with AAV and glucocorticoid contraindications who received avacopan plus standard-of-care through a French early-access program (2020-2023); 30 of 31 had kidney vasculitis, and glucocorticoids were withdrawn before month 3 in 23 patients.
Key findings
25 of 31 patients (81%) had a favorable outcome with no severe adverse event. Estimated GFR rose from 19 to 35 mL/min/1.73m2 at 12 months (P<0.05), independent of kidney biopsy findings. One patient developed refractory AAV and two relapsed; ANCA remained positive in 55.5% at 12 months.
Safety
Two patients had severe adverse events (hepatitis and age-related macular degeneration) leading to avacopan withdrawal.
Category
Research
Source
Rheumatology (Oxford)
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