Avacopan for the Treatment of ANCA-Associated Vasculitis
In the ADVOCATE trial RCT (n=331 on cyclophosphamide or rituximab), avacopan, a C5a receptor inhibitor, was non-inferior but not superior to prednisone taper with respect to remission at week 26 and was superior to prednisone taper with respect to sustained remission at week 52.
Source:
New England Journal of Medicine
SPS commentary:
According to an editorial, this trial heralds a change in the treatment of ANCA-associated vasculitis that was previously unthinkable — the possibility of inducing disease remission without glucocorticoids, though patients did receive a brief course of glucocorticoids during the screening phase or early in the trial as prednisone was being tapered off and could receive glucocorticoids as rescue medication. it notes that as glucocorticoids are not only used in the remission-induction phase of severe ANCA-associated vasculitis but are also often used to manage minor disease relapses, thus contributing to the cumulative burden of glucocorticoid toxicity, therefore, it will be of interest to explore whether avacopan could also replace glucocorticoids during management of minor relapses.