Kidney Week

Abstract: FR-PO0657

Rituximab with or Without Avacopan in ANCA-Associated Vasculitis with Severe Kidney Involvement: A Retrospective Comparative Cohort Study

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

• Juanet, Cristián, Mayo Clinic Minnesota, Rochester, Minnesota, United States

Cristián Juanet, MD

• Hassi Román, María Isabel, Universidad de los Andes, Santiago, Santiago, Chile

María Isabel Hassi Román, MD

• Cara, Anila, Mayo Clinic Minnesota, Rochester, Minnesota, United States

Anila Cara, MD

• García Majado, Cristina, Mayo Clinic Minnesota, Rochester, Minnesota, United States

Cristina García Majado

• Arriola Montenegro, Jose J., Mayo Clinic Minnesota, Rochester, Minnesota, United States

Jose J. Arriola Montenegro, MD

• Laxamana, Trisha D., Mayo Clinic Minnesota, Rochester, Minnesota, United States

Trisha D. Laxamana, MD

• Berti, Gian Marco, Mayo Clinic Minnesota, Rochester, Minnesota, United States

Gian Marco Berti, MD, PhD

• Vargas-Brochero, Maria J., Mayo Clinic Minnesota, Rochester, Minnesota, United States

Maria J. Vargas-Brochero, MD, MS

• Thongprayoon, Charat, Mayo Clinic Minnesota, Rochester, Minnesota, United States

Charat Thongprayoon, MD, FASN

• Specks, Ulrich, Mayo Clinic Minnesota, Rochester, Minnesota, United States

Ulrich Specks, MD

• Fervenza, Fernando C., Mayo Clinic Minnesota, Rochester, Minnesota, United States

Fernando C. Fervenza, MD, PhD, FASN

• Zand, Ladan, Mayo Clinic Minnesota, Rochester, Minnesota, United States

Ladan Zand, MD

Background

Avacopan has demonstrated efficacy as a glucocorticoid-sparing therapy in ANCA-associated vasculitis (AAV), but its benefit in patients with severe renal involvement treated with rituximab remains uncertain.

Methods

Retrospective cohort study performed at Mayo Clinic comparing rituximab (RTX) + avacopan (n=31) vs RTX (n=120) in AAV with eGFR<30 mL/min/1.73m2 at induction (2010–2025), with follow-up to 24 months. Co-primary outcomes: time to renal remission (≤25% eGFR decline + hematuria ≤10 RBC/HPF), analyzed by Kaplan-Meier and Cox regression; and longitudinal eGFR trajectory, analyzed by linear mixed-effects models.

Results

Baseline characteristics were comparable. Median eGFR was 16.0 mL/min/1.73m2 and 15.0 mL/min/1.73m2 in the RTX alone and RTX + avacopan groups, respectively; dialysis was required at baseline in 12.5% and 16.1%, respectively. Median follow-up was 21.4 months in the RTX only group and 10.1 months in the RTX + avacopan group. Avacopan reduced cumulative prednisone at 12 months (1.79g vs 4.34g; p<0.001) and shortened time to prednisone discontinuation (3.4 vs 7.3 months; p<0.001). Unadjusted Kaplan-Meier analysis showed lower cumulative probability of renal remission in the avacopan group (log-rank p=0.039). To account for potential confounders, an adjusted Cox proportional hazards model was fitted (age, ANCA serotype, baseline eGFR, and dialysis requirement); renal remission did not differ significantly between groups (HR 0.75 for avacopan; p=0.237). Longitudinal eGFR trajectories did not differ significantly between groups; results were consistent across models adjusting for clinical and histopathological variables. One patient (3.2%) discontinued avacopan due to drug-induced liver injury (ALT/AST ≥3× ULN), with transaminase normalization following discontinuation. No cases of severe hepatotoxicity were observed.

Conclusion

In this small cohort of patients with AAV and severe kidney involvement with low eGFR, we did not observe short-term beneficial effect on renal function, but avacopan resulted in substantional reduction in corticosteroid use with few adverse effects.