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Kidney Week

Abstract: TH-PO601

Outcomes of COVID-19 Infection in Patients with ANCA-Associated Vasculitis Receiving Avacopan Therapy

Session Information

Category: Glomerular Diseases

  • 1402 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Aqeel, Faten, Johns Hopkins University, Baltimore, Maryland, United States
  • Zonozi, Reza, Harvard University, Cambridge, Massachusetts, United States
  • Jeyabalan, Anushya, Harvard University, Cambridge, Massachusetts, United States
  • Sauvage, Gabriel, Harvard University, Cambridge, Massachusetts, United States
  • Niles, John, Harvard University, Cambridge, Massachusetts, United States
  • Geetha, Duvuru, Johns Hopkins University, Baltimore, Maryland, United States
Background

The complement C5a-C5aR signaling axis plays a crucial role in the pathogenesis of ANCA-associated vasculitis (AAV) and COVID-19 infection. Avacopan, a C5aR antagonist is approved as an adjunct therapy for remission induction in AAV. Vilobelimab, a C5a antibody was granted Emergency Use Authorization by the FDA for severe COVID-19 infection. In AAV, COVID-19 infection poses an increased mortality risk. Additionally, the risk of severe COVID-19 infection is increased in patients receiving rituximab and glucocorticosteroids.

Methods

We performed an observational, retrospective study examining outcomes of patients with AAV treated with avacopan and who had COVID-19 infection. Data on ANCA type, immunosuppressive treatment, COVID-19 course, and COVID-19 vaccination status were retrieved after a review of the electronic medical records.

Results

A total of 7 patients were included. The mean (SD) age was 65.1 (±17.5) years old. Four patients had MPO-AAV and 3 patients had PR3-AAV. Two patients had a relapsing disease, and the rest had a new diagnosis of AAV. Six patients received at least 3 COVID-19 vaccines and a single patient received two COVID-19 vaccines. Five patients received a combination of rituximab, cyclophosphamide, glucocorticoids, and avacopan, whereas 2 patients received rituximab, glucocorticoids, and avacopan. The mean (SD) time from the date of initiation of induction immunosuppression to avacopan initiation was 20 (±21.5) days. The mean (SD) time from avacopan initiation to COVID-19 infection was 110 (±62) days. At the time of COVID-19 infection, all patients remained on rituximab therapy. The mean (SD) time between the last rituximab dose and the onset of COVID-19 infection was 63.8 (±57.1) days. Avacopan was continued in all patients. COVID-19 treatment included Paxlovid (n=3), Bebtelovimab (n=1), Molnupiravir (n=1), remdesivir and dexamethasone (n=1), and no treatment (n=1). All patients had mild symptoms except one patient who was hospitalized and died from severe COVID-19 infection.

Conclusion

COVID-19 clinical course appears to be mild in the majority AAV patients treated with avacopan, with a single patient experiencing severe COVID-19 infection and death. More studies are needed to explore the interplay between C5a blockade and infectious complications from SARS-CoV-2.