Avacopan for ANCA-associated vasculitis: Beyond the 52-week treatment course

The landmark ADVOCATE trial, which lead to the approval of Avacopan (AVP) as adjunctive treatment of ANCA-associated vasculitis (AAV), treated patients with AVP for 52 weeks. In the real-world, some patients are prescribed AVP for a longer duration. In this study, we performed a multi-center retrospective cohort study of 15 adult patients with new and relapsing AAV treated with AVP for a duration of 52 weeks or longer. During a mean follow-up period of 96 (21) weeks, 1/15 patients experienced AAV flare, and none progressed to end-stage kidney disease. On last follow-up, the mean estimated glomerular filtration rate (eGFR) rise from baseline was 16 mL/min/1.73m². Infections were the most reported adverse effects including 5 infections requiring hospitalization. No abnormal liver function tests were reported during these prolonged courses of AVP beyond 52 weeks. AVP therapy for AAV showed excellent remission rates with marked improvement of the eGFR at 26- and 52-weeks follow-up. By prolonging the treatment with AVP beyond 52 weeks, the improvement in eGFR was sustained during the additional AVP treatment period. Infection complications were the most observed adverse effects. Further data on the longer-term use of AVP is needed.