Abstract: FR-PO0658
Avacopan in ANCA-Associated Vasculitis with Severe Kidney Disease
Session Information
- Glomerular Diseases: Clinical, Outcomes, and Therapeutics Research - ANCA/FSGS
October 23, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Glomerular Diseases
- 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics
Authors
- Kattubadi, Ayeesha, Johns Hopkins University, Baltimore, Maryland, United States
- Bilen, Yara, University of Pennsylvania, Philadelphia, Pennsylvania, United States
- Geara, Abdallah Sassine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
- Geetha, Duvuru, Johns Hopkins University, Baltimore, Maryland, United States
Background
Avacopan, an oral selective C5a receptor antagonist, is approved for the treatment of severe ANCA-associated vasculitis (AAV). The ADVOCATE trial which showed avacopan's non-inferiority to prednisone for remission at 26 weeks and superiority at 52 weeks excluded individuals with an eGFR <15 ml/min/1.73 m2 or those requiring renal replacement therapy (RRT). Consequently, data are limited regarding the efficacy and safety of avacopan in patients with the most severe forms of renal injury.
Methods
We conducted a multicenter retrospective cohort study across two academic medical centers. We identified patients with AAV and severe renal impairment, defined as an eGFR < 15 ml/min/1.73 m2 at the time of diagnosis. Clinical data were extracted from electronic medical records. Primary outcomes were the rates of clinical remission at 26 and 52 weeks and recovery from RRT. Secondary outcomes included disease relapse and serious infections requiring hospitalization.
Results
18 patients were included (mean age 56 years; 66% male; 88% Caucasian). The median BVAS was 24 (±10 SD). Pulmonary involvement was present in 77% of patients. MPO-ANCA was positive in 55%. The mean baseline eGFR was 13 mL/min/1.73 m2, with 61% (n=11) requiring RRT at presentation. Induction regimens included PLEX (39%), rituximab monotherapy (61%), cyclophosphamide (22%), or a combination of both (17%).
Avacopan was initiated at a mean of 39 days (±43 SD) post-diagnosis. LFTs were monitored per protocol; no LFT abnormalities were observed. Glucocorticoids were successfully discontinued in 83% of patients, with a mean time to prednisone cessation of 74 days (±73 SD). At 26 weeks of follow-up, 77% of patients achieved clinical remission and 61% had sustained clinical remission at 52 weeks. Notably, 45% (n=5) of those initially requiring RRT were liberated from RRT. One relapse and two serious infections requiring hospitalization occurred.
Conclusion
In this real-world cohort of patients with profound renal impairment treatment with avacopan was characterized by successful glucocorticoid withdrawal and a favorable safety profile and no hepatotoxicity. The observation of clinical remission and liberation from RRT in nearly half of the RRT dependent patients warrants further prospective investigation in this high-risk population.