Avacopan versus a Prednisone Taper in Patients with ANCA-Associated Vasculitis Without Kidney Involvement in a Phase 3 Trial

Poster presenter: Christian Pagnoux, MD, MSc, MPH, Associate Professor, Mount Sinai Hospital, Vasculitis Clinic, University of Toronto, Canada

Poster title: Avacopan versus a Prednisone Taper in Patients with ANCA-Associated Vasculitis Without Kidney Involvement in a Phase 3 Trial

Poster session C: Monday, Nov. 18

What is your poster about? 

“This poster describes outcomes among patients with granulomatosis with polyangiitis (GPA) or microscopic polyangiitis (MPA), two types of anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV), without kidney involvement in the phase 3 ADVOCATE trial. This cornerstone trial was led by Peter A. Merkel, MD, MPH, and David R.W. Jayne, MD, and I am the presenting co-author at ACR Convergence 2024​ of this subgroup analysis. Treatment with avacopan regimen versus a prednisone taper regimen was accompanied in this subset of patients without kidney involvement by higher sustained remission at week 52, lower relapse rate, lower glucocorticoid dose and toxicity, in addition to improvements in health-related quality of life, and a comparable safety profile.”

Why did you decide to investigate this topic?

“It is important to be aware that GPA and MPA have a variety of clinical manifestations. GPA and MPA frequently affect the kidneys, yet some patients have no kidney involvement. Studies and data on treatment with avacopan in this group are limited.”

What are you working on next related to this research?

“Real-life data are already accumulating, which perfectly and consistently reproduced the findings from the ADVOCATE trial. However, more studies and data are needed to establish the role of avacopan and further confirm its possible benefits in patients excluded from the trial, such as those with more severe renal disease (eGFR < 15 ml/min) or, on the opposite, less systemic or more limited GPA or MPA. The optimal duration of avacopan and how to combine it with rituximab in the long term also need to be determined. I participate in several registries, including from the Canadian Vasculitis Study Group (CanVasc), and look forward to enrolling patients in the many international therapeutic trials coming up in AAV.”

What excites you most about your work?

“With a background in internal medicine and passion for rare diseases, my work over the past years and in the future, I hope, offers the opportunity to make a meaningful impact on AAV patients’ lives. By engaging with patients facing the challenges of this condition, which can often include a long road to diagnosis, I am inspired to seek innovative solutions that support their care journey. As new data and advancements emerge, we are able to envision more enhanced treatment plans, potentially leading to improved patient outcomes, longer remission periods, and a reduced risk of relapse. The key studies being shared at this year’s ACR Convergence demonstrate the dedication my colleagues and I have toward understanding how to better treat AAV patients and ultimately improve their outcomes.”

What are you most looking forward to at ACR Convergence 2024 in Washington, D.C.?

“It’s an exciting time in scientific innovation at this year’s ACR conference, especially for those living with AAV. I was proud to be a co-author of several key studies being presented at ACR on the treatment of patients with AAV, including around the role of avacopan as part of the treatment plan. This work is particularly important because it reinforces the urgency of efficient diagnosis and demonstrates that remission is possible for those living with AAV if they’re diagnosed quickly enough and have found the right treatment option. I’m looking forward to learning more about the scientific advancements within this particularly challenging rare disease.”