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TOPLINE
Among patients with granulomatosis and polyangiitis or microscopic polyangiitis, treatment with avacopan alongside standard immunosuppressive therapy was associated with high clinical remission rates, reduced glucocorticoid use, improved kidney function, and better quality of life over 52 weeks.
METHODOLOGY
- Researchers conducted a prospective, observational study across 18 Italian rheumatology and nephrology centres to evaluate the real-world effectiveness and safety of avacopan in patients with antineutrophil cytoplasmic antibody-associated vasculitis.
- They included 46 patients with newly diagnosed or relapsing granulomatosis and polyangiitis or microscopic polyangiitis who initiated avacopan therapy between May 2022 and October 2024; the mean age of the patients was 59 years, and 63% were women.
- Patients started avacopan alongside rituximab and/or cyclophosphamide, with or without glucocorticoids; the mean baseline glucocorticoid dose was 23 mg/d.
- The primary endpoint was glucocorticoid-free clinical remission at weeks 12, 26, and 52. Glucocorticoid-free clinical remission was defined as a Birmingham Vasculitis Activity Score of 0, with no use of glucocorticoids over the previous 4 weeks.
TAKEAWAY
- Clinical remission was reached by 78%, 88%, and 97% of evaluable patients at weeks 12, 26, and 52, respectively, and glucocorticoid-free remission by 20%, 37%, and 53%, respectively; the mean glucocorticoid dose reduced from 23 mg/d at baseline to 5 mg/d by week 12 (P < .001).
- Among 32 patients with kidney involvement, the median estimated glomerular filtration rate increased from 30.5 to 53.5 mL/min/1.73 m² by week 52 (P = .002); proteinuria levels, serum creatinine levels, and haematuria improved by week 12 (P < .05 for all).
- Patient-reported quality of life improved by week 12 and remained improved from baseline at week 52, with further gains in physical function.
- Infections were the most frequent adverse events; four patients stopped avacopan because of infections, and two older patients with long-standing relapsing disease died from infections.
IN PRACTICE
"[The] findings provide independent, prospective real-world evidence on the clinical outcomes associated with avacopan treatment in routine practice," the authors of the study wrote.
SOURCE
The study was led by Luca Quartuccio, MD, PhD, University of Udine, Udine, Italy. It was published online on October 11, 2026, in ACR Open Rheumatology.
LIMITATIONS
The study had a relatively small sample size and lacked a comparator group. The treatment protocol was not standardised, and doctors independently determined the glucocorticoid tapering schedule and maintenance therapy.
DISCLOSURES
No funding information was provided for the study. The authors reported having no conflicts of interest.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
