Addendum to AAV Recommendations Addresses Avacopan

An addendum to recommendations from the Canadian Vasculitis Research Network for the management of patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis supports consideration of avacopan as part of the induction regimen for patients with granulomatosis with polyangiitis (GPA) or microscopic polyangiitis (MPA) requiring induction with rituximab or cyclophosphamide. The addendum was published in the journal Rheumatology.

The recommendations were first published in 2016 and updated in 2020. Avacopan later received approval from the US Food and Drug Administration in October 2021 and from Health Canada in April 2022 as adjunctive treatment for adult patients with severe active ANCA-associated vasculitis (GPA and MPA) in combination with standard background therapy, including glucocorticoids.

The addendum includes 3 new recommendations regarding the use of avacopan that are based on evidence published before September 2022 as well as expert consensus. Specifically, the addendum advises:

• Oral avacopan (30 mg twice daily) can be considered for remission induction in patients with newly diagnosed or relapsing GPA or MPA treated with cyclophosphamide or rituximab;
• After avacopan is started, an expedited glucocorticoid-tapering protocol that aims for discontinuation by the end of week 4 should be considered; and
• Avacopan initiated as part of induction therapy can be used for 1 year.

“These new recommendations provide guidance for the use of avacopan in ANCA-associated vasculitis while acknowledging the need for additional studies,” wrote corresponding author David Turgeon, MD, of Mount Sinai Hospital, University of Toronto, in Ontario, Canada, and coauthors.

Reference

Turgeon D, Bakowsky V, Baldwin C, et al. CanVasc consensus recommendations for the use of avacopan in antineutrophil cytoplasm antibody-associated vasculitis: 2022 addendum. Rheumatology. 2023;62(8):2646-2651. doi:10.1093/rheumatology/kead087