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Updated: May 13, 2025

Human Liver Microphysiological System for Assessing Drug-Induced Liver Toxicity In Vitro
Published on: January 31, 2022
Drug-induced liver injury due to avacopan improved by mycophenolate mofetil: A case report
Ryo Yamashita1, Yusuke Izumi1, Keisuke Takane1
1Department of General Medicine, The Jikei University School of Medicine, Daisan Hospital, Komae-si, Tokyo, Japan.
Rationale:
Antineutrophil cytoplasmic antibody-associated vasculitis (AAV) is a systemic necrotizing vasculitis that predominantly affects small vessels. Glucocorticoids are the standard therapeutic agents for AAV; however, their long-term use can cause damage. Avacopan is a small-molecule complement component 5a receptor antagonist that reduces vasculitis and can potentially be used as an alternative to glucocorticoids. However, its therapeutic efficacy remains unknown, and drug-induced liver injury (DILI) is a concern associated with its use.
Patient Concerns:
A 74-year-old woman with a history of granulomatosis with polyangiitis was admitted to our hospital with a 1-week history of fatigue and anorexia.
Diagnoses:
She had started avacopan 3 months before hospitalization. Blood tests showed severe liver injury, and since other diseases were ruled out, she was diagnosed with DILI secondary to avacopan.
Interventions:
Avacopan was discontinued, and glucocorticoid doses were increased and ursodeoxycholic acid was administered; however, the liver injury did not resolve. Therefore, mycophenolate mofetil (MMF) was started.
Outcomes:
The liver injury was resolved after starting MMF.
Lessons:
MMF is effective in treating DILI caused by avacopan.
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