Treatment With Avacopan in ANCA-Associated Vasculitis With Kidney Involvement.

Area of Science:

• Rheumatology and Nephrology
• Clinical Trial Analysis
• Pharmacotherapy

Background:

• Kidney disease significantly impacts long-term outcomes for patients diagnosed with granulomatosis with polyangiitis (GPA) and microscopic polyangiitis (MPA).
• The ADVOCATE trial investigated avacopan's efficacy, and this analysis focuses on a specific subgroup with baseline kidney involvement.

Purpose of the Study:

• To evaluate the effect of avacopan on kidney outcomes in patients with GPA or MPA and kidney involvement.
• To compare avacopan's efficacy and safety against prednisone taper in this specific patient subgroup.

Main Methods:

• A post hoc analysis of 268 patients with GPA or MPA and kidney involvement from the ADVOCATE trial.
• Key outcomes included remission rates, sustained remission, relapse rates, changes in estimated glomerular filtration rate (eGFR), albuminuria, hematuria, and glucocorticoid (GC) toxicity.
• Patients were stratified by baseline eGFR categories to analyze kidney function recovery.

Main Results:

• Similar remission rates were observed between the avacopan and prednisone taper groups at weeks 26 and 52.
• The avacopan group showed a significantly lower relapse rate after remission (9.4% vs. 20.9%).
• Avacopan demonstrated improved kidney function recovery, faster reduction in albuminuria and hematuria, and reduced glucocorticoid toxicity (GTI) compared to prednisone.

Conclusions:

• Avacopan regimens achieved comparable remission rates to prednisone taper in GPA/MPA patients with kidney involvement.
• Avacopan significantly improved kidney function recovery, reduced markers of kidney damage (albuminuria, hematuria), and decreased GC-related toxicity.
• The safety profile of avacopan in this subset was acceptable, with no new safety concerns identified.