Abstract: SA-PO0854
Avacopan in Patients with ANCA-Associated Vasculitis and Severe Kidney Disease
Session Information
- Glomerular Management: Real-World Lessons and Emerging Therapies
November 08, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Glomerular Diseases
- 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics
Authors
- Singh, Aditi, Johns Hopkins Medicine, Baltimore, Maryland, United States
- Bilen, Yara, University of Pennsylvania, Philadelphia, Pennsylvania, United States
- Tamargo, Christina Lauren, Johns Hopkins Medicine, Baltimore, Maryland, United States
- Geara, Abdallah Sassine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
- Geetha, Duvuru, Johns Hopkins Bayview Medical Center, Baltimore, Maryland, United States
Background
Avacopan, a C5a receptor antagonist, has been approved for ANCA-associated vasculitis (AAV) based on the results of the ADVOCATE trial. However, the ADVOCATE trial excluded patients with severe kidney disease.
Methods
We conducted a retrospective study of AAV patients at two academic centers between 2022 and 2025. Inclusion criteria included a diagnosis of AAV, severe kidney disease defined as eGFR <15ml/min/1.73m2 or RRT dependency at diagnosis, and initiation of avacopan. Clinical and treatment data were extracted from the electronic medical record. Primary outcomes were remission, RRT dependency, and eGFR rise, all at week 26. Secondary outcomes included relapse rate and infections requiring hospitalization.
Results
Fifteen patients were included in the analysis. The mean age was 57, 66% were male, and 53.3% had MPO positivity. All patients had kidney involvement, and 73% had lung involvement. Mean (SD) eGFR at diagnosis was 10 ml/min/1.73m2 (3). Mean (SD) Birmingham vasculitis activity score (BVAS) was 24 (11), and 60% were RRT-dependent (Figure). Eighty percent received rituximab induction, and 33% received plasmapheresis. The mean time to initiation of avacopan was 43 days, with 80% successfully tapered off prednisone. In 40 weeks of follow-up, 60% achieved clinical remission at week 26, with 33% achieving liberation from RRT. The mean eGFR rise was 27 ml/min/1.73m2 in non-RRT-dependent patients (Figure). One patient experienced relapse, and 20% had infections needing hospitalization.
Conclusion
Our study demonstrated that avacopan use in AAV patients with severe kidney disease was associated with substantial eGFR recovery in non-RRT patients and had an acceptable safety profile. However, ESKD occurred in 53% of patients, and these observations warrant further study on this cohort.