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Kidney Week

Abstract: SA-PO873

Avacopan in ANCA Vasculitis: A Real-World Experience

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
  • Geara, Abdallah Sassine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
  • Sattui, Sebastian E., University of Pittsburgh, Pittsburgh, Pennsylvania, United States
  • Le, Dustin, Johns Hopkins University, Baltimore, Maryland, United States
  • Sauvage, Gabriel, Harvard University, Cambridge, Massachusetts, United States
  • Ayoub, Isabelle, The Ohio State University, Columbus, Ohio, United States
  • Cortazar, Frank B., St. Peter's Health Partners, Albany, New York, United States
  • Shaikh, Aisha, Washington University in St Louis, St Louis, Missouri, United States
  • Bomback, Andrew S., Columbia University, New York, New York, United States
  • Diffie, Colin, Washington University in St Louis, St Louis, Missouri, United States
  • Guaman, Karina P., Columbia University, New York, New York, United States
  • Singer, Ora, University of Michigan, Ann Arbor, Michigan, United States
  • Bulbin, David Henry, Geisinger Medical Center, Danville, Pennsylvania, United States
  • George, Jason Christopher, Geisinger Medical Center, Danville, Pennsylvania, United States
  • Niles, John, Harvard University, Cambridge, Massachusetts, United States
  • Geetha, Duvuru, Johns Hopkins University, Baltimore, Maryland, United States
Background

Avacopan (AVP) is a recently approved adjunct therapy for remission induction of ANCA-associated vasculitis (AAV). Data on real-world use of AVP in AAV are lacking.

Methods

We performed a multi-center retrospective observational study of adult patients with AAV treated with AVP and collected clinical, treatment and outcome data. Data are presented as mean (±SD), median (IQR), or number (percent).

Results

Eighty patients were included. Mean age was 59 (17) years, 65% were female, 74% had MPO ANCA, and 95% had kidney involvement. AVP was used with rituximab ± cyclophosphamide in 95% of patients. AVP was started 8.8 (19.6) weeks after glucocorticoid initiation with 58 (73%) patients discontinuing prednisone 7.5 (18) weeks after starting AVP. At diagnosis, 19 (24%) patients had eGFR <15 with 8 dialysis dependent. Outcomes are summarized in Table 1. Among the 60 (75%) patients with hematuria at diagnosis, 70% had resolution of hematuria 14 (14) weeks after AVP initiation. Nadir proteinuria of 0.3 (0.1 – 0.7) g/g was achieved 10 (21) weeks after AVP initiation. The cumulative dose of IV methylprednisolone was 2.4 (1.4) g, and 12-week oral prednisone was 1.8 (1.1) g. At week 26, 5 of 39 (13%) patients remained on prednisone.

AVP was stopped in 25 patients: 11 after 52 weeks, and 14 before 52 weeks due to adverse events. At a mean follow-up time of 8 (6) months, 5 had disease relapse, 7 had infections requiring hospitalization, 3 remained dialysis-dependent, and 3 died.

Conclusion

AAV patients treated with AVP have high clinical remission rates at weeks 26 and 52 and sustained improvement in eGFR.

Data are presented as mean (SD), median (IQR), or number (percent)
Abbreviations: T = time in weeks; N = Number; BVAS, Birmingham Vasculitis Activity Score; eGFR, estimated glomerular filtration rate; uPCR, urine protein-to-creatinine ratio.